Devices and Methods for Dilating a Paranasal Sinus Opening and for Treating Sinusitis

ABSTRACT

Medical devices which are adapted to be inserted into a patient for a limited period of time using minimally invasive insertion procedures for dilating a stenotic opening, such as a stenotic sinus opening, are provided. The devices and methods can be used for treating sinusitis and other nasal and/or sinus disorders.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims priority benefit of U.S. Provisional ApplicationSer. No. 61/605,000, filed on Feb. 29, 2012 and U.S. ProvisionalApplication Ser. No. 61/756,877, filed on Jan. 25, 2013, the disclosureof each of which application is herein incorporated by reference in itsentirety.

This application is related to U.S. patent application Ser. Nos.13/219,505 and 13/219,497, both filed Aug. 26, 2011, the disclosures ofeach of which are incorporated herein by reference.

INTRODUCTION

The bones in the skull and face contain a series of air-filled cavitiesknown as paranasal sinuses that are connected by passageways. Theparanasal sinuses include frontal sinuses, sphenoid sinuses andmaxillary sinuses. The paranasal sinuses are lined with mucus-producingepithelial tissue and are in communication with the nasal cavity.Normally, mucus produced by the epithelial tissue slowly drains out ofeach sinus through an opening known as an ostium. If the epithelialtissue of one of these passageways becomes inflamed for any reason, thecavities which drain through that passageway can become blocked. Thisblockage can be periodic (resulting in episodes of pain) or chronic.This interference with drainage of mucus (e.g., occlusion of a sinusostium) can result in mucosal congestion within the paranasal sinuses.Chronic mucosal congestion of the sinuses can cause damage to theepithelium that lines the sinus with subsequent decreased oxygen tensionand microbial growth (e.g., a sinus infection).

The term “sinusitis” refers generally to any inflammation or infectionof the paranasal sinuses caused by bacteria, viruses, fungi (molds),allergies or combinations thereof. It has been estimated that chronicsinusitis (e.g., lasting more than 3 months) results in 18 million to 22million physician office visits per year in the United States. Patientswho suffer from sinusitis typically experience at least some of thefollowing symptoms: headaches or facial pain, nasal congestion orpost-nasal drainage, difficulty breathing through one or both nostrils,bad breath and/or pain in the upper teeth. Thus, one of the ways totreat sinusitis is by restoring the lost mucus flow.

SUMMARY

Medical devices which are adapted to be inserted into a patient for alimited period of time using minimally invasive insertion procedures fordilating a stenotic opening, such as a stenotic sinus opening, areprovided. The devices and methods can be used for treating sinusitis andother nasal and/or sinus disorders.

In Situ Osmotic Anchor

In some embodiments, a device for dilating a stenotic opening of amaxillary sinus in a subject is provided. The device Includes: (a) aself-expanding osmotic driver configured to expand an expandable portionfrom a non-expanded configuration to an expanded configuration, theosmotic driver including a first osmotic driver and a second osmoticdriver positioned distally to the first driver; and (b) the expandableportion disposed peripherally around the first and second osmoticdrivers and configured to expand from the non-expanded configuration tothe expanded configuration, where the non-expanded configuration issized to be positioned within the stenotic opening. The second driver isconfigured to have (i) a faster rate of expansion than a rate ofexpansion of the first driver, and (ii) a duration of expansion lessthan a duration of expansion of the first driver, whereby the seconddriver is configured to prevent the device from being expelled from thestenotic opening and into the nasal cavity during device expansion.

Embodiments of the device may include that the second driver isconfigured to have a duration of expansion of 2 hours or less.

Embodiments of the device may include that the first and second driversinclude an osmotically active agent, the second osmotic driver having aconcentration of the agent greater than the concentration of the agentin the first driver.

Embodiments of the device may include that the osmotically active agentin the second driver has a concentration of 50 to 70 wt % and theosmotically active agent in the first driver has a concentration of 30to 50 wt %.

Embodiments of the device may include that each of the first and seconddrivers includes an osmopolymer, the second driver having aconcentration of the osmopolymer that is less than the concentration ofthe osmopolymer in the first driver.

Embodiments of the device may include that the osmopolymer in the firstdriver has a concentration of 30 to 70 wt % and the osmopolymer in thesecond driver has a concentration of 20 to 50 wt %.

Embodiments of the device may include that the second driver isconfigured to have a diameter greater than the diameter of the firstdriver during a period of stenotic opening dilation, and the seconddriver is configured to have a diameter less than the diameter of thefirst driver following said period of stenotic opening dilation.

Embodiments of the device may include that the period of stenoticopening dilation is 0.5 hours or more.

Embodiments of the device may include that the period of stenoticopening dilation is 2 hours or less.

Embodiments of the device may include that the device includes a conduitdefining an interior lumen, where the conduit includes a distal endconfigured to be in fluid communication with an interior cavity of themaxillary sinus in the subject and a proximal end configured to be influid communication with a nasal cavity in the subject, and where theconduit is configured to allow fluid flow between the interior cavity ofthe maxillary sinus and the nasal cavity when the device is positionedwithin the stenotic opening.

Embodiments of the device may include that the expandable portionincludes a semipermeable membrane.

Embodiments of the device may include that the device includes aproximal anchor proximate to the proximal end of the device, where theproximal anchor is configured to prevent the device from moving into amaxillary sinus cavity of the subject during device placement andexpansion.

Wicking Agent

In some embodiments, a device for dilating a stenotic opening of aparanasal sinus in a subject is provided. The device includes aself-expanding osmotic driver, the self-expanding osmotic driverconfigured to expand an expandable portion from a non-expandedconfiguration to an expanded configuration, the expandable portiondisposed peripherally around the driver and configured to expand fromthe non-expanded configuration to the expanded configuration, where thenon-expanded configuration is sized to be positioned within the stenoticopening. The osmotic driver includes a wicking agent.

Embodiments of the device may include that the wicking agent includeshydroxypropyl cellulose.

Embodiments of the device may include that the wicking agent has anaverage particle size of 100 μm or less.

Embodiments of the device may include that the driver is configured toexpand the expandable portion from the non-expanded configuration to theexpanded configuration over a period of 0.5 hours or more.

Embodiments of the device may include that the driver is configured toexpand the expandable portion from the non-expanded configuration to theexpanded configuration over a period of 2 hours or less.

Embodiments of the device may include that the driver includes anosmotically active agent.

Embodiments of the device may include that the device includes a conduitdefining an interior lumen, where the conduit includes a distal endconfigured to be in fluid communication with an interior cavity of theparanasal sinus in the subject and a proximal end configured to be influid communication with a nasal cavity in the subject, and where theconduit is configured to allow fluid flow between the interior cavity ofthe paranasal sinus and the nasal cavity when the device is positionedwithin the stenotic opening.

Embodiments of the device may include that the expandable portionincludes a semipermeable membrane.

Embodiments of the device may include that the device includes aproximal anchor proximate to the proximal end of the device, where theproximal anchor is configured to maintain the device within the stenoticopening.

Insertion Device Circumferential Trigger

In some embodiments, a device for inserting a sinus dilator into astenotic opening of a paranasal sinus of a patient is provided. Theinsertion device includes: a handheld member including (i) a handlesized to be grasped by a user's hand and having a grippable exteriorsurface; and (ii) a trigger activated by a user's thumb or finger; ahollow elongated member having a proximal end coupled to the handheldmember and a distal end having an opening to an interior cavity of thehollow elongated member and a retention interface for removably couplingto a sinus dilator; and an interior elongated member extending withinthe interior cavity of the hollow elongated member and operativelyconnected to the trigger. The trigger extends around 25% or more of theexterior surface of the handle.

Embodiments of the insertion device may include that the trigger extendsaround 50% or more of the exterior surface of the handle.

Embodiments of the insertion device may include that the trigger extendsaround 75% or more of the exterior surface of the handle.

Embodiments of the insertion device may include that the trigger extendsaround the entire exterior surface of the handle.

Embodiments of the insertion device may include that the handle has acircular cross-section and the trigger extends around a percentage of acircumference of the handle.

Insertion Device with Low Profile Retention Tip

In some embodiments, a device for inserting a sinus dilator into astenotic opening of a paranasal sinus of a patient is provided. Theinsertion device includes a handheld member including a handle and atrigger, a hollow elongated member having a proximal end coupled to thehandheld member and a distal end coupled to a retention tip, and aninterior elongated member coupled to the trigger and extending within aninterior cavity of the hollow elongated member. The retention tip isangularly coupled to the distal end of the hollow elongated member withrespect to the central passageway of the hollow elongated member. Theretention tip also includes an opening to an interior cavity of thehollow elongated member.

Embodiments of the insertion device may include that a distal end of theinterior elongated member is configured to extend through the opening inthe retention tip into an interior cavity of the retention tip.

Embodiments of the insertion device may include that the interiorelongated member is relatively displaceable with respect to the hollowelongated member such that upon actuation of the trigger, the interiorelongated member is displaced proximally within the hollow elongatedmember. In certain embodiments, the interior elongated member isconfigured to decouple from the sinus dilator when the interiorelongated member is displaced proximally within the hollow elongatedmember.

Embodiments of the insertion device may include that the interiorelongated member is relatively displaceable with respect to the hollowelongated member such that upon actuation of the trigger, the interiorelongated member is displaced distally within the hollow elongatedmember. In certain embodiments, the interior elongated member isconfigured to decouple the sinus dilator from the retention interfacewhen the interior elongated member is displaced distally within thehollow elongated member.

Embodiments of the insertion device may include that the distal end ofthe hollow elongated member is substantially linear.

Embodiments of the insertion device may include that the retention tipis coupled to the distal end of the hollow elongated member at aposition between the proximal and distal ends of the retention tip.

Embodiments of the insertion device may include that the retention tiphas a length of 5 mm or less.

Humidity-Regulating Agent

In some embodiments, a packaged dilator for dilating a stenotic openingof a paranasal sinus in a subject is provided. The packaged dilatorincludes a device for dilating a stenotic opening of a paranasal sinusin a subject. The device includes: i) an expandable portion configuredto expand from a non-expanded configuration to an expandedconfiguration, where the non-expanded configuration is sized to bepositioned within the stenotic opening; and ii) a self-expanding osmoticdriver configured to expand the expandable portion from the non-expandedconfiguration to the expanded configuration, where the expandedconfiguration dilates the stenotic opening. The packaged dilator alsoincludes a sealed package containing the device, the sealed packagebeing water impermeable and containing a humidity-regulating agent.

Embodiments of the packaged dilator may include that the osmotic driverincludes a semipermeable membrane that includes a hydrophilic polymerhaving an equilibrium water content range, and the humidity-regulatingagent maintains the water content of the hydrophilic polymer within theequilibrium water content range.

Embodiments of the packaged dilator may include that the osmotic driverincludes an expandable osmotic core that expands upon exposure to water,and the humidity-regulating agent is configured to prevent the osmoticcore from expanding while in the sealed package.

Embodiments of the packaged dilator may include that thehumidity-regulating agent is configured to maintain the relativehumidity within the sealed package at a relative humidity of from 30% to60%.

Embodiments of the packaged dilator may include that the driver isconfigured to expand the expandable portion from the non-expandedconfiguration to the expanded configuration over a period of 0.5 hoursor more.

Embodiments of the packaged dilator may include that the driver isconfigured to expand the expandable portion from the non-expandedconfiguration to the expanded configuration over a period of 2 hours orless.

Embodiments of the packaged dilator may include that the driver includesan osmotically active agent.

Embodiments of the packaged dilator may include that the device includesa conduit defining an interior lumen, where the conduit includes adistal end configured to be in fluid communication with an interiorlumen of the paranasal sinus in the subject and a proximal endconfigured to be in fluid communication with a nasal cavity in thesubject, and where the conduit is configured to allow fluid flow betweenthe interior lumen of the paranasal sinus and the nasal cavity when thedevice is positioned within the stenotic opening.

Embodiments of the packaged dilator may include that the expandableportion includes a semipermeable membrane.

Embodiments of the packaged dilator may include that the device includesa proximal anchor proximate to the proximal end of the device, where theproximal anchor is configured to maintain the device within the stenoticopening.

Sinus Dilator Proximal Anchor

In some embodiments, a device for dilating a stenotic opening of amaxillary sinus in a subject is provided. The device includes: (a) aself-expanding driver configured to expand an expandable portion from anon-expanded configuration to an expanded configuration; and (b) theexpandable portion disposed peripherally around the driver andconfigured to expand from the non-expanded configuration to the expandedconfiguration, where the non-expanded configuration is sized to bepositioned within the stenotic opening; and (c) a proximal anchorproximate to the proximal end of the device, the proximal anchor beingsized and configured to prevent the device from passing through thestenotic opening into the maxillary sinus cavity. The device has anelongated proximal end having a sufficient length to contact a wall ofthe nasal cavity facing the stenotic opening when the device ispositioned within the stenotic opening. Embodiments of the device mayinclude that the device has a length, measured from a point on thedevice that is immediately adjacent to the nasal passageway side of thesinus opening, to the proximal end of the device, of 3 to 6 mm.

Embodiments of the device may include that the elongated proximal endforms at least a portion of the proximal anchor.

Embodiments of the device may include that the elongated proximal end isconfigured to prevent the device from being squeezed out of the sinusopening and into the nasal passageway during device expansion.

Embodiments of the device may include that the proximal anchor includesa member extending radially outward from an axis of the device.

Embodiments of the device may include that the proximal anchor includesa pair of said radially outward extending members.

Embodiments of the device may include that the members are positioned onopposite sides of a longitudinal axis of the device.

Embodiments of the device may include that each of the members extendsradially outward from the axis of the device a distance of 3 mm or more.

Embodiments of the device may include that each of the members extendsradially outward from the axis of the device a distance of 4 to 8 mm.

Embodiments of the device may include that the driver is configured toexpand the expandable portion to a diameter of 7 mm or less.

Embodiments of the device may include that the driver is configured toexpand the expandable portion from the non-expanded configuration to theexpanded configuration over a period of 0.5 hours or more.

Embodiments of the device may include that the driver is configured toexpand the expandable portion from the non-expanded configuration to theexpanded configuration over a period of 2 hours or less.

Embodiments of the device may include that the driver is configured toexpand the expandable portion by at least one of osmosis, a shape memorymetal, a spring, a swellable polymer, a thermal expansion of a gas, athermal expansion of a liquid, a gas-generating chemical reaction, and aphase change expansion of a material.

Embodiments of the device may include that the driver includes anosmotically active agent.

Embodiments of the device may include that the expandable portionincludes a semipermeable membrane.

Embodiments of the device may include that the device includes a conduitdefining an interior lumen, where the conduit includes a distal endconfigured to be in fluid communication with an interior lumen of themaxillary sinus in the subject and a proximal end configured to be influid communication with a nasal cavity in the subject, and where theconduit is configured to allow fluid flow between the maxillary sinuscavity and the nasal cavity when the device is positioned within thestenotic opening.

Sinus Dilator Cone-Shaped Distal Tip

In some embodiments, a device for dilating a stenotic opening of aparanasal sinus in a subject is provided. The device includes: (a) aself-expanding driver configured to expand an expandable portion from anon-expanded configuration to an expanded configuration, the expandableportion disposed peripherally around the driver and configured to expandfrom the non-expanded configuration to the expanded configuration, wherethe non-expanded configuration is sized to be positioned within thestenotic opening; and (b) a tip disposed on a distal end of the device,the tip being cone-shaped.

Embodiments of the device may include that the tip is comprised of amaterial such as metal, plastic, or ceramic.

Embodiments of the device may include that the tip has an apex angle of20° to 70°.

Embodiments of the device may include that the tip has an apex angle of50° to 70°.

Embodiments of the device may include that the tip has an apex angle of60°.

Embodiments of the device may include that the tip includes a proximalsurface in contact with the driver and configured to direct expansion ofthe driver radially outwardly from an axis of the device.

Embodiments of the device may include that the device has a passagewayextending through at least a distal end of the device and the tipincludes a proximally extending post that engages the passageway.

Embodiments of the device may include that the device includes a conduitdefining an interior lumen, where the conduit includes a distal endconfigured to be in fluid communication with an interior lumen of theparanasal sinus in the subject and a proximal end configured to be influid communication with a nasal cavity in the subject, and where theconduit is configured to allow fluid flow between the interior lumen ofthe paranasal sinus and the nasal cavity when the device is positionedwithin the stenotic opening.

Embodiments of the device may include that the driver is configured toexpand the expandable portion from the non-expanded configuration to theexpanded configuration over a period of 0.5 hours or more.

Embodiments of the device may include that the driver is configured toexpand the expandable portion from the non-expanded configuration to theexpanded configuration over a period of 2 hours or less.

Embodiments of the device may include that the driver is configured toexpand the expandable portion by at least one of osmosis, a shape memorymetal, a spring, a swellable polymer, a thermal expansion of a gas, athermal expansion of a liquid, a gas-generating chemical reaction and aphase change expansion of a material.

Embodiments of the device may include that the driver includes anosmotically active agent.

Embodiments of the device may include that the expandable portionincludes a semipermeable membrane.

Embodiments of the device may include that the device includes aproximal anchor proximate to the proximal end of the device, where theproximal anchor is configured to maintain the device within the stenoticopening.

Sinus Dilator with a Drug Reservoir

In some embodiments, a device for dilating a stenotic opening of aparanasal sinus in a subject is provided. The device includes: (a) aself-expanding osmotic driver including a first osmotic driver and asecond osmotic driver positioned distal to the first driver, theself-expanding osmotic driver configured to expand an expandable portionfrom a non-expanded configuration to an expanded configuration, theexpandable portion disposed peripherally around the first and secondosmotic drivers and configured to expand from the non-expandedconfiguration to the expanded configuration, where the non-expandedconfiguration is sized to be positioned within the stenotic opening; and(b) a drug reservoir positioned between the first and second drivers andwithin the periphery of the expandable portion.

Embodiments of the device may include that the drug reservoir isconfigured to release a drug as the first and second osmotic driversexpand from a non-expanded configuration to an expanded configuration.

Embodiments of the device may include that the expandable portionincludes an elastic semipermeable membrane, where the drug diffusesthrough the membrane during use of the device.

Embodiments of the device may include that the drug is water soluble.

Embodiments of the device may include that the drug is an antibiotic, ananti-inflammatory drug, a local anesthetic, an analgesic, or acombination thereof.

Embodiments of the device may include that the driver is configured toexpand the expandable portion from the non-expanded configuration to theexpanded configuration over a period of 0.5 hours or more.

Embodiments of the device may include that the driver is configured toexpand the expandable portion from the non-expanded configuration to theexpanded configuration over a period of 2 hours or less.

Embodiments of the device may include that each of the first and secondosmotic drivers includes an osmotically active agent.

Embodiments of the device may include that the device includes a conduitdefining an interior lumen, where the conduit includes a distal endconfigured to be in fluid communication with an interior cavity of theparanasal sinus in the subject and a proximal end configured to be influid communication with a nasal cavity in the subject, and where theconduit is configured to allow fluid flow between the interior cavity ofthe paranasal sinus and the nasal cavity when the device is positionedwithin the stenotic opening.

Embodiments of the device may include that the expandable portionincludes a semipermeable membrane.

Embodiments of the device may include that the device includes aproximal anchor proximate to the proximal end of the device, where theproximal anchor is configured to maintain the device within the stenoticopening during device expansion.

Sinus Dilator with a Drug in the Osmotic Driver

In some embodiments, a device for dilating a stenotic opening of aparanasal sinus in a subject is provided. The device includes aself-expanding osmotic driver including an osmotically active agent, theself-expanding osmotic driver configured to expand an expandable portionfrom a non-expanded configuration to an expanded configuration, theexpandable portion disposed peripherally around the driver andconfigured to expand from the non-expanded configuration to the expandedconfiguration, where the non-expanded configuration is sized to bepositioned within the stenotic opening. The osmotically active agentincludes a drug.

Embodiments of the device may include that the expandable portionincludes an elastic semipermeable membrane, where the drug diffusesthrough the membrane during use of the device.

Embodiments of the device may include that the drug is water soluble.

Embodiments of the device may include that the drug is an antibiotic, ananti-inflammatory drug, a local anesthetic, an analgesic, or acombination thereof.

Embodiments of the device may include that the driver is configured toexpand the expandable portion from the non-expanded configuration to theexpanded configuration over a period of 0.5 hours or more.

Embodiments of the device may include that the driver is configured toexpand the expandable portion from the non-expanded configuration to theexpanded configuration over a period of 2 hours or less.

Embodiments of the device may include that each of the first and secondosmotic drivers includes an osmotically active agent.

Embodiments of the device may include that the device includes a conduitdefining an interior lumen, where the conduit includes a distal endconfigured to be in fluid communication with an interior cavity of theparanasal sinus in the subject and a proximal end configured to be influid communication with a nasal cavity in the subject, and where theconduit is configured to allow fluid flow between the interior cavity ofthe paranasal sinus and the nasal cavity when the device is positionedwithin the stenotic opening.

Embodiments of the device may include that the device includes aproximal anchor proximate to the proximal end of the device, where theproximal anchor is configured to maintain the device within the stenoticopening during device expansion.

Tablet Compression Force

In some embodiments, a method of making a device for dilating a stenoticopening of a paranasal sinus in a subject is provided. The methodincludes forming an osmotic driver in the form of a tablet comprised ofan osmotically active agent, an osmopolymer and an expandable membranedisposed peripherally therearound, the driver being configured to expandfrom a non-expanded configuration to an expanded configuration, wherethe non-expanded configuration is sized to be positioned within thestenotic opening. The forming includes compressing the tablet such thatthe tablet is formed having a smooth outer surface with no flashing.

Embodiments of the method may include that the forming includescompressing the osmotically active agent and the osmopolymer in a tabletpress.

Embodiments of the method may include that the compressing includescompressing the tablet using a compression force of 100 lbs or less.

Embodiments of the method may include that the compressing includescompressing the tablet using a compression force of 20 to 70 lbs.

Embodiments of the method may include that the compressing includescompressing the tablet using a compression pressure of 15 to 65 mPa.

Embodiments of the method may include that the compressing includescompressing the tablet using a compression pressure of 30 to 65 mPa.

Embodiments of the method may include that the osmotically active agentis a salt.

Embodiments of the method may include that the osmopolymer is ahydrogel-forming osmopolymer.

Embodiments of the method may include that the expandable membrane is anelastic semipermeable membrane.

Insertion Device Recessed Push Rod

In some embodiments, a device for inserting a sinus dilator into astenotic opening of a paranasal sinus of a patient is provided. Theinsertion device includes a handheld member including a handle and atrigger, a hollow elongated member having a proximal end coupled to thehandheld member and a distal end having an opening to an interior cavityof the hollow elongated member, and an interior elongated memberextending within the interior cavity of the hollow elongated member. Thehollow elongated member includes a retention interface configured toremovably couple to a proximal end of a sinus dilator, and where adistal end of the interior elongated member is recessed from the distalend of the hollow elongated member a distance sufficient to accommodateinsertion of the proximal end of the sinus dilator.

Embodiments of the insertion device may include that the interiorelongated member is relatively displaceable with respect to the hollowelongated member such that upon actuation of the trigger, the interiorelongated member is displaced distally within the hollow elongatedmember.

Embodiments of the insertion device may include that the trigger isslidably coupled to the handle and the trigger is coupled to theinterior elongated member such that sliding the trigger relative to thehandle displaces the interior elongated member distally relative to thehollow elongated member.

Embodiments of the insertion device may include that the proximal end ofthe sinus dilator includes an elongated proximal anchor.

Insertion Device Distal Tip Angle

In some embodiments, a device for inserting a sinus dilator into astenotic opening of a maxillary sinus of a patient is provided. Theinsertion device includes: a handheld member including a handle and atrigger; a hollow elongated member having a proximal end coupled to thehandheld member and a distal end having a retention interface forremovably coupling to the sinus dilator and a middle section extendingbetween the distal and proximal ends, the middle section having an axis;an interior elongated member extending within the interior cavity of thehollow elongated member. The distal end of the hollow elongated memberis oriented at an angle of 105° to 115° relative to the axis.

Embodiments of the insertion device may include that the angle is 110°.

BRIEF DESCRIPTION OF THE FIGURES

FIG. 1 is a partial cutaway view of a human head showing the positionsof the frontal sinuses (FS) and the maxillary sinuses (MS);

FIG. 2 is a sectional view of a portion of a human head showing thepositions of the frontal sinus (FS) and the sphenoid sinus (SS);

FIG. 3 is a side view of an osmotically driven device for dilating aparanasal sinus opening, in a non-expanded configuration, according toembodiments of the present disclosure;

FIG. 4 is an end view of the device shown in FIG. 3;

FIG. 5 is a sectional view of the device shown in FIGS. 3 and 4, takenalong line 5-5;

FIG. 6 is an end view of an osmotically driven device for dilating aparanasal sinus opening, in a non-expanded configuration, according toembodiments of the present disclosure;

FIG. 7 is a sectional view of the device shown in FIG. 6, taken alongline 7-7;

FIG. 8 is a perspective view of an insertion device for inserting adilation device, according to embodiments of the present disclosure;

FIG. 9 is an enlarged view of the distal end of the insertion device;

FIG. 10 is a side view of the devices shown in FIG. 8;

FIG. 11 is an end view of the device shown in FIG. 10;

FIG. 12 is a sectional view of the devices shown in FIG. 11, taken alongline 12-12;

FIG. 13 is a side view of the devices shown in FIGS. 10 to 12, with atrigger activated to displace the dilation device, according toembodiments of the present disclosure;

FIG. 14 is a sectional view of the devices shown in FIG. 13;

FIG. 15 is a perspective view of the devices shown in FIG. 13;

FIG. 16 is a perspective view of the devices shown in FIG. 14;

FIG. 17 is a side view of an insertion device and a dilation device usedto insert the dilation device into the opening of a maxillary sinuswhich is shown in section, according to embodiments of the presentdisclosure;

FIG. 18 is a side view of the dilation device shown in FIG. 17 afterbeing inserted into a maxillary sinus opening;

FIG. 19 is a side view of the distal end of an insertion device with adilator mounted thereon, according to embodiments of the presentdisclosure;

FIG. 20 is a side view of the distal end of the insertion device shownin FIG. 9;

FIG. 21 is a sectional view of the insertion device and dilation deviceshown in FIG. 19;

FIG. 22 is a sectional view of an insertion device with a dilatormounted thereon, according to embodiments of the present disclosure; and

FIG. 23 is a sectional view of the insertion device and dilation deviceshown in FIG. 22, with the dilator deployed, according to embodiments ofthe present disclosure.

Before embodiments of the present disclosure are described in greaterdetail, it is to be understood that these embodiments are not limited tothe particular aspects described, and as such may, of course, vary. Itis also to be understood that the terminology used herein is for thepurpose of describing particular embodiments only, and is not intendedto be limiting, since the scope of the embodiments is embodied by theappended claims.

Where a range of values is provided, it is understood that eachintervening value, to the tenth of the unit of the lower limit unlessthe context clearly dictates otherwise, between the upper and lowerlimit of that range and any other stated or intervening value in thatstated range, is encompassed within embodiments of the presentdisclosure. The upper and lower limits of these smaller ranges mayindependently be included in the smaller ranges and are also encompassedwithin the embodiments, subject to any specifically excluded limit inthe stated range. Where the stated range includes one or both of thelimits, ranges excluding either or both of those included limits arealso included in the embodiments.

Unless defined otherwise, all technical and scientific terms used hereinhave the same meaning as commonly understood by one of ordinary skill inthe art to which this invention belongs. Although any methods andmaterials similar or equivalent to those described herein can also beused in the practice or testing of the present embodiments,representative illustrative methods and materials are now described.

It is noted that, as used herein and in the appended claims, thesingular forms “a”, “an”, and “the” include plural referents unless thecontext clearly dictates otherwise. It is further noted that the claimsmay be drafted to exclude any optional element. As such, this statementis intended to serve as antecedent basis for use of such exclusiveterminology as “solely,” “only” and the like in connection with therecitation of claim elements, or use of a “negative” limitation.

As will be apparent to those of skill in the art upon reading thisdisclosure, each of the individual embodiments described and illustratedherein has discrete components and features which may be readilyseparated from or combined with the features of any of the other severalembodiments without departing from the scope or spirit of the presentinvention. In addition, it will be readily apparent to one of ordinaryskill in the art in light of the teachings herein that certain changesand modifications may be made thereto without departing from the spiritand scope of the appended claims. Any recited method can be carried outin the order of events recited or in any other order which is logicallypossible.

All publications and patents cited in this specification are hereinincorporated by reference as if each individual publication or patentwere specifically and individually indicated to be incorporated byreference and are incorporated herein by reference to disclose anddescribe the methods and/or materials in connection with which thepublications are cited. To the extent such publications may set outdefinitions of a term that conflict with the explicit or implicitdefinition of the present disclosure, the definition of the presentdisclosure controls. The citation of any publication is for itsdisclosure prior to the filing date and should not be construed as anadmission that the present invention is not entitled to antedate suchpublication by virtue of prior invention. Further, the dates ofpublication provided may be different from the actual publication dateswhich may need to be independently confirmed.

DETAILED DESCRIPTION

Medical devices which are adapted to be inserted into a patient for alimited period of time using minimally invasive insertion procedures fordilating a stenotic opening, such as a stenotic sinus opening, areprovided. The devices and methods can be used for treating sinusitis andother nasal and/or sinus disorders.

Devices and Methods for Dilating a Stenotic Opening of a Paranasal Sinusin a Subject

Aspects of the present disclosure include devices and methods fordilating a stenotic opening of a paranasal sinus in a subject. Thedevice (e.g., sinus dilator) includes an expandable portion configuredto expand from a non-expanded configuration to an expandedconfiguration, where the non-expanded configuration is sized to bepositioned within the stenotic opening, and a driver configured toexpand the expandable portion from the non-expanded configuration to theexpanded configuration, where the expanded configuration dilates thestenotic opening.

The term “stenotic opening” refers to an abnormal narrowing of abiological passageway, such as a paranasal sinus opening. In certainembodiments, the device includes an osmotic driver configured to expandan expandable portion from a non-expanded configuration to an expandedconfiguration, and the expandable portion disposed peripherally aroundthe driver and configured to expand from the non-expanded configurationto the expanded configuration, where the non-expanded configuration issized to be positioned within the stenotic opening.

In certain embodiments, the driver is self-expanding when in contactwith tissue of the subject. By “self-expanding” is meant that the drivermay expand from the non-expanded configuration to the expandedconfiguration without external intervention from a user or a health carepractitioner. For example, the self-expanding driver may beself-contained, such that the driver is configured to expand withoutconnection to an external pressure source. As such, self-expandingdrivers as described herein function without the need for an externalpressure source or a pressure monitoring device (e.g., as with a ballooncatheter). In some cases, the self-expanding driver expands from thenon-expanded configuration to the expanded configuration upon absorbingfluid from the surrounding environment when the device is in use. Forinstance, the self-expanding driver may expand from the non-expandedconfiguration to the expanded configuration upon absorbing water fromthe surrounding tissues of the stenotic opening when the device is inuse. Self-expanding drivers may be configured to expand the expandableportion of the device by various ways, such as, but not limited to, anosmotic agent, a swellable agent (e.g., a swellable polymer),combinations thereof, and the like. In some instances, the driver isconfigured to expand the expandable portion by at least one of osmosis,a shape memory metal, a spring, a swellable polymer, a thermal expansionof a gas, a thermal expansion of a liquid, a gas-generating chemicalreaction and a phase change expansion of a material.

In certain embodiments, the driver includes an osmotic agent. As usedherein, the terms “osmotic agent,” “osmotically active agent” and“osmoagent” are used interchangeably and refer to an agent thatfacilitates the imbibition of water from a region of high waterpotential (e.g., low solute concentration) through a semipermeablemembrane to a region of low water potential (e.g., high soluteconcentration) until a state of dynamic equilibrium is reached. In someinstances, the osmotically active agent may be configured to absorbwater flowing through a semipermeable membrane from the surroundingtissues after insertion of the device into the stenotic opening of thesubject and expand. In certain embodiments, the osmotic agent isconfigured to have a zero order rate of expansion. By “zero order” ismeant that the rate of volume expansion of the osmotic agent isapproximately constant over time and is independent of the surroundingsolute concentration.

In certain embodiments, the driver is configured to begin expanding uponinsertion of the device into the stenotic opening of the subject. Theterms “insert” or “insertion” are used herein interchangeably todescribe the positioning of a device in a stenotic opening of a subjectfor a period of time. In some instances, the driver is configured tobegin expanding within seconds or minutes after insertion of the deviceinto the stenotic opening. In some cases, the driver is configured tobegin expanding in 60 min or less, such as 45 min or less, or 30 min orless, including 10 min or less, or 5 min or less, such as 1 min or less,after insertion of the device into the stenotic opening. In someinstances, the driver is configured to continue to expand for a certainperiod of time after the device has been inserted into the stenoticopening of the subject. For example, the driver may be configured tocontinue to expand for 30 min or more, such as 45 min or more, including60 min or more, or 90 min or more, 120 min or more, or 180 min or more,or 240 min or more, or 300 min or more after the device has beeninserted into the stenotic opening of the subject.

In certain embodiments, the driver takes a certain amount of time toexpand the expandable portion from the non-expanded configuration to theexpanded configuration. For instance, in some cases the driver isconfigured to expand the expandable portion from the non-expandedconfiguration to the expanded configuration over a period of 0.5 hoursor more, such as 1 hour or more, or 2 hours or more, or 4 hours or more,or 6 hours or more, or 8 hours or more, or 10 hours or more, or 12 hoursor more, or 24 hours or more, or 48 hours or more, or 72 hours or more,etc. In some instances, the driver is configured to expand theexpandable portion from the non-expanded configuration to the expandedconfiguration over a period of 24 hours or less, such as 12 hours orless, or 10 hours or less, or 8 hours or less, or 6 hours or less, or 4hours or less, or 2 hours or less, 1.5 hours or less, or 1 hours orless, or 0.5 hours or less. As such, in certain instances, the driver isconfigured to expand the expandable portion from the non-expandedconfiguration to the expanded configuration over a period ranging from0.5 hours to 24 hours, such as 0.5 hour to 12 hours, including 0.5 hourto 10 hours, or 1 hour to 8 hours, or 1 hour to 6 hours, or 1 hour to 4hours, or 1 hour to 2 hours.

In certain embodiments, the driver is configured to expand theexpandable portion to a diameter of 10 mm or less, such as 9 mm or less,or 8 mm or less, or 7 mm or less, or 6 mm or less, or 5 mm or less, or 4mm or less, or 3 mm or less, or 2 mm or less, or 1 mm or less. In somecases, the driver is configured to expand the expandable portion to adiameter of 7 mm or less.

As used herein, the term “distal” refers to the end of a device (e.g., asinus dilator device or insertion device), or a component thereof, thatis positioned towards the end of the device that is inserted through orclosest to a paranasal sinus opening of the subject. For example, thedistal end of a sinus dilator device is the end of the device that isinserted through the paranasal sinus opening of the subject and remainswithin the sinus cavity during use. A device (e.g., a sinus dilatordevice or insertion device), or a component thereof, may also include aproximal end. As used herein, the term “proximal” refers to the end ofthe device, or component thereof, that is positioned towards the end ofthe device that remains on the nasal cavity side of the stenotic openingor remain external to the subject during use. For example, the proximalend of a sinus dilator device is the end of the device that remains onthe nasal cavity side of the stenotic opening when the sinus dilatordevice is positioned in the stenotic opening during use.

Embodiments of the presently disclosed devices include an expandableportion. The expandable portion is configured to expand from anon-expanded configuration to an expanded configuration. In certainembodiments, the expandable portion is configured to expand in size froma non-expanded configuration to an expanded configuration. Theexpandable portion may be configured to expand in size withoutsignificantly increasing in volume, such as by stretching in one or moredimensions from the non-expanded configuration. The expandable portionmay be positioned peripherally around the driver. For instance, theexpandable portion may be disposed on an exterior surface of the driver.In these embodiments, expansion of the underlying driver expands theexpandable portion from its non-expanded configuration to its expandedconfiguration.

Aspects of the present disclosure include devices that have anexpandable portion, where the expandable portion includes a membrane.The membrane may be an elastic membrane, such that the membrane isconfigured to expand from the non-expanded configuration to the expandedconfiguration, as described herein. In certain instances, the membraneis a semipermeable membrane. By “semipermeable” is meant a membrane thatis permeable to solvent but not significantly permeable to solute acrossa concentration gradient, such as a membrane that allows solvent (e.g.,water) molecules to pass through the membrane by osmosis from a regionof low solute concentration to a region of high solute concentrationuntil a state of dynamic equilibrium is reached. For instance, asemipermeable membrane may be configured to allow water to pass throughthe membrane by osmosis from a region of low solute concentration (e.g.,high water potential) to a region of high solute concentration (e.g.,low water potential) until a state of dynamic equilibrium is reached.

In certain embodiments, the expandable portion includes a membrane,where the membrane is an impermeable membrane. By “impermeable” is meanta membrane that is not significantly permeable to solvent or solute.Impermeable membranes do not allow significant amounts of solvent (e.g.,water) or solute molecules to pass through the membrane by osmosis evenin the presence of a solute concentration gradient across the membrane.

In certain embodiments, the device includes a conduit that defines aninterior lumen of the device. The conduit includes a distal endconfigured to be in fluid communication with an interior lumen of theparanasal sinus in the subject. In some cases, the conduit may beconfigured to allow fluid flow between the paranasal sinus in thesubject and the nasal cavity when the device is positioned within thestenotic opening. In some instances, the conduit is configured to allowfluid and/or air to flow from the paranasal sinus to the nasal cavity ofthe subject. For example, the conduit may be configured to facilitatedrainage of fluid from the paranasal sinus in the subject to the nasalcavity when the device is positioned within the stenotic opening. Insome cases, the conduit may be configured to facilitate the flow of airinto and out of the paranasal sinus in the subject.

In certain embodiments, the driver is disposed on an exterior surface ofthe conduit. The driver may be disposed on the exterior surface of theconduit at a position between the distal end and the proximal end of theconduit. For example, the driver may be positioned between a distalanchor at the distal end of the conduit and a proximal anchor at theproximal end of the conduit. As described herein, the expandable portionmay be positioned peripherally around the driver. Thus, in theseembodiments, the driver is disposed between the exterior surface of theconduit and the overlying expandable portion. Expansion of the driverexpands the overlying expandable portion from its non-expandedconfiguration to its expanded configuration.

Aspects of the driver further include embodiments where the drivercompletely surrounds the conduit. The driver may be disposed on theexterior surface of the conduit around the entire periphery of theconduit. In certain embodiments, the driver surrounds the conduit aroundthe central portion of the conduit, where the distal end of the conduitmay have a distal anchor and the proximal end of the conduit may have aproximal anchor, as described in more detail herein. In some instances,the driver includes one or more subunits, where each subunit is disposedon the exterior surface of the conduit. The one or more driver subunitsmay be positioned such that they are in contact with the adjacent one ormore driver subunits. Alternatively, the one or more driver subunits maybe positioned such that there is a channel between the driver subunits.In certain instances, the channel between the driver subunits extendsalong the exterior surface of the conduit from the distal end of theconduit to the proximal end of the conduit. The channels may beconfigured to allow fluid and/or air to flow between the paranasal sinusand the nasal cavity of the subject. In certain cases, the channels areconfigured to allow fluid and/or air to flow from the paranasal sinus tothe nasal cavity of the subject. For example, the channels may beconfigured to facilitate drainage of fluid from the paranasal sinus inthe subject to the nasal cavity when the device is positioned within thestenotic opening. In some cases, the channels may be configured tofacilitate the flow of air into and out of the paranasal sinus in thesubject.

In certain embodiments, the walls of the conduit are substantiallyrigid. The walls of the conduit may be substantially rigid, such thatthe conduit maintains substantially the same shape and size during useof the device. For instance, the conduit may maintain substantially thesame interior diameter during use of the device. In some instances, thewalls of the conduit are substantially rigid, such that pressure exertedon the exterior surface of the conduit by the driver does notsignificantly decrease the interior diameter of the conduit. Forexample, the walls of the conduit may be substantially rigid, such thatthe conduit is not crushed by the driver during use of the device. Insome instances, the driver is configured to expand radially outward fromthe conduit. As discussed above, the walls of the conduit may besubstantially rigid, thus expansion of the driver may be directedradially outward away from the substantially rigid walls of the conduit.Expansion of the driver radially outward from the conduit may facilitatedilation of the stenotic opening.

In certain embodiments, the walls of the conduit are substantiallynon-collapsible. The walls of the conduit may be substantiallynon-collapsible, such that the conduit is configured to maintain anopening in the conduit during use of the device. For example, the wallsof the conduit may be substantially non-collapsible, such that theconduit is not crushed by the driver during use of the device. In somecases, a non-collapsible conduit maintains substantially the same shapeand size during use of the device. For instance, the conduit maymaintain substantially the same interior diameter during use of thedevice. In some instances, the walls of the conduit are substantiallynon-collapsible, such that pressure exerted on the exterior surface ofthe conduit by the driver does not significantly decrease the interiordiameter of the conduit. As discussed above, the driver may beconfigured to expand radially outward from the conduit and, as such, thewalls of the conduit may be substantially non-collapsible, such thatexpansion of the driver is directed radially outward away from thesubstantially non-collapsible walls of the conduit. Expansion of thedriver radially outward from the conduit may facilitate dilation of thestenotic opening. A substantially non-collapsible conduit may be rigid,as described above, or may be flexible and adapted to bend from itsoriginal shape. In some instances, a flexible conduit facilitatesinsertion of the sinus dilator in a sinus ostium.

In certain instances, the conduit includes a membrane. The conduitmembrane may be a semipermeable membrane. In certain instances, theconduit membrane is a non-collapsible semipermeable membrane. In somecases, the conduit membrane is a rigid semipermeable membrane. Themembrane may be configured to be permeable to solvent but notsignificantly permeable to solute across a concentration gradient, suchthat the membrane allows solvent (e.g., water) molecules to pass throughthe membrane by osmosis from a region of low solute concentration to aregion of high solute concentration until a state of dynamic equilibriumis reached. For instance, the membrane may be configured to allow waterto pass through the membrane by osmosis from an interior lumen of theconduit to the surrounding driver until a state of dynamic equilibriumis reached.

In some embodiments, the device includes a conduit that includes asemipermeable membrane, a surrounding driver, and an overlyingexpandable portion that includes a semipermeable membrane. In theseembodiments, the device may be configured to allow solvent (e.g., water)to pass through both the semipermeable expandable portion membrane byosmosis and through the semipermeable conduit membrane by osmosis. Forexample, the device may be configured to allow solvent to pass throughthe semipermeable expandable membrane from the surrounding tissues tothe underlying driver, and also allow solvent to pass through thesemipermeable conduit membrane from an interior lumen of the conduit tothe surrounding driver.

In other embodiments, the device includes a conduit that includes asemipermeable membrane, a surrounding driver, and an overlyingexpandable portion that includes an impermeable membrane. In theseembodiments, the device may be configured to allow solvent (e.g., water)to pass through the semipermeable conduit membrane by osmosis but notallow significant amounts of solvent (e.g., water) to pass through theimpermeable expandable portion membrane. For example, the device may beconfigured to allow solvent to pass through the semipermeable conduitmembrane from an interior lumen of the conduit to the surroundingdriver, but not allow significant amount of solvent to pass through theimpermeable expandable portion membrane to the driver.

In yet other embodiments, the conduit includes an impermeable material.In some cases, the impermeable material is an impermeable membrane. Forinstance, the device may include a conduit that includes an impermeablemembrane, a surrounding driver, and an overlying expandable portion thatincludes a semipermeable membrane. In these embodiments, the device maybe configured to allow solvent (e.g., water) to pass through thesemipermeable expandable membrane by osmosis but not allow significantamounts of solvent (e.g., water) to pass through the impermeable conduitmembrane. For example, the device may be configured to allow solvent topass through the semipermeable expandable portion membrane from thesurrounding tissues to the underlying driver, but not allow significantamount of solvent to pass through the impermeable conduit membrane fromthe interior lumen of the conduit to the surrounding driver.

Aspects of the device may include a distal anchor configured to maintainthe device within the stenotic opening during use of the device. Thedistal anchor may be connected to the device proximate to the distal endof the device. For example, the distal anchor may be connected to thedevice proximate to the distal end of the conduit. In some cases, thedistal anchor is configured to prevent the device from prematureexplantation from the stenotic opening. The distal anchor may facilitatemaintaining the device within the stenotic opening for a desired periodof time until the device is removed from the stenotic opening by theuser or a health care professional. In certain embodiments, the distalanchor is a mechanical anchor, such as, but not limited to, a hook, abarb, a clamp, a tether and the like. In certain cases, the distalanchor is configured to maintain the device within the stenotic openingby having a diameter that is greater than the diameter of the stenoticopening.

In some instances, the device has a frictional surface on an exteriorsurface of the device. The frictional surface may be configured toincrease the friction between the exterior surface of the device and thesurrounding tissues when the device is in use. Increasing the frictionbetween the exterior surface of the device and the surrounding tissuesmay facilitate retention of the device in the stenotic opening of thesubject during use. For example, the frictional surface may have a roughtopography that includes an exterior surface shaped as, for example,washboard, rings, waffle pattern, snow tire pattern, pebble finish,shark skin texture, combinations thereof, and the like.

In certain cases, the device includes an adhesive disposed on anexterior surface of the device. In some cases, the membrane includes anadhesive. The membrane may be configured such that the adhesive elutesto the external surface of the device during use. The adhesive mayfacilitate retention of the device in the stenotic opening of thepatient during use. Examples of suitable adhesives include, but are notlimited to, carbomer, low molecular weight hydroxypropylmethylcellulose, polyvinyl pyrrolidone, combinations thereof, and thelike.

In some cases, the distal anchor is configured to allow the device to beinserted into the stenotic opening. The distal anchor may have anoutside diameter that is substantially the same as the outside diameterof the device when the device is in a non-expanded configuration. Insome instances, the distal anchor has an outside diameter that isgreater than the diameter of the conduit. In certain embodiments, thedistal anchor has a tapered shape, such that the distal end of thedistal anchor has a diameter that is less than the diameter of theproximal end of the distal anchor (see e.g., FIGS. 5 and 6). In certainembodiments, the distal anchor is configured such that the distal anchorhas a diameter that is smaller during insertion of the device into thestenotic opening as compared to the diameter of the distal anchor afterthe anchor portion of the device has been inserted into the paranasalsinus.

In certain embodiments, the distal anchor is a flexible anchor. In somecases, the flexible distal anchor is configured to have a configurationthat has a smaller diameter during insertion of the device into thestenotic opening as compared to the diameter of the flexible distalanchor after the anchor portion of the device has been inserted into theparanasal sinus. For instance, the flexible distal anchor may beconfigured to fold into a configuration that has a smaller diameterduring insertion of the device into the stenotic opening as compared tothe diameter of the flexible distal anchor after the anchor portion ofthe device has been inserted into the paranasal sinus. The distal anchormay include one or more subunits that are connected to and extendradially outward from the conduit. The subunits of the distal anchor maybe flexible, such that during insertion of the device into the stenoticopening, the subunits fold into a configuration where the distal anchorhas an outside diameter that is less than the diameter of the distalanchor when the subunits are fully extended. Once the distal end of thedevice has been inserted into the paranasal sinus, the subunits may befree to unfold back to their extended configuration, thus anchoring thedevice within the stenotic opening.

Aspects of the device may include a proximal anchor configured tomaintain the device within the stenotic opening during use of the device(see e.g., FIGS. 3-7). The proximal anchor may be connected to thedevice proximate to the proximal end of the device. For example, theproximal anchor may be connected to the device proximate to the proximalend of the conduit. In some cases, the proximal anchor is configured toprevent the device from being inserted too far or completely into theparanasal sinus of the subject. The proximal anchor may facilitatemaintaining the device within the stenotic opening for a desired periodof time until the device is removed from the stenotic opening by theuser or a health care professional. In some cases, the proximal anchorhas an outside diameter that is greater than the diameter of theconduit. For instance, the proximal anchor may have an outside diameterthat is greater than the diameter of the device when the device is in anon-expanded configuration.

In some embodiments, the device includes an attachment portionconfigured to facilitate removal of the device from the stenoticopening. The attachment portion may be configured to allow a removaldevice to be attached to the device. For example, the attachment portionof the device may include a structure, such as, but not limited to, aloop, a tether or a hook. The removal device may include a correspondingstructure that allows for attachment of the removal device to theattachment portion of the device. In some instances, the device includesa loop and the removal device includes a hook. In other embodiments, thedevice includes a hook and the removal device includes a loop. In eitherembodiment, insertion of the hook into the loop connects the device tothe removal device and may facilitate removal of the device from thestenotic opening.

In some cases, the attachment portion may protrude from the device tofacilitate connection of the removal device to the attachment portion ofthe device. The attachment portion may be disposed at or near theproximal end of the device to facilitate removal of the device from thestenotic opening. For example, the attachment portion may be disposed onthe proximal anchor at the proximal end of the device. In certain cases,the attachment portion may be connected to the conduit proximate to theproximal end of the device.

Additional aspects of the devices and methods for dilating a stenoticopening of a paranasal sinus in a subject are described in more detailin U.S. patent application Ser. Nos. 13/219,505 and 13/219,497, bothfiled Aug. 26, 2011, the disclosures of each of which are incorporatedherein by reference.

Devices and Methods for Inserting a Sinus Dilator

Aspects of the present disclosure include an insertion device adapted toinsert a sinus dilator into a stenotic opening of a paranasal sinus in asubject patient using minimally invasive insertion procedures. Theinsertion device and methods can be used to treat sinusitis and othernasal and/or sinus disorders.

The insertion device includes a handheld member coupled to a hollowelongated member. By “hollow” is meant that the hollow elongated memberincludes a central passageway that extends through the length of thehollow elongated member. For example, the hollow elongated member may bea tube or a cannula. In certain embodiments, the proximal end of thehollow elongated member may be coupled to a handheld member and thedistal end of the hollow elongated member is dimensioned to pass througha nasal cavity of a subject. A sinus dilator, as described above, may becoupled to the distal end of an insertion device, which may then beinserted into the nasal cavity of a subject. The sinus dilator is thenpositioned within a stenotic sinus opening, which may be partially orcompletely occluded.

In certain embodiments, the insertion device also includes an interiorelongated member positioned within the hollow elongated member andextending at least a portion of the length of the hollow elongatedmember. The interior elongated member has a proximal end coupled to thehandheld member and dimensioned to fit within the hollow elongatedmember. The distal end of the interior elongated member may include aretention interface that removably couples to a sinus dilator. The sinusdilator may be coupled to the retention interface (e.g., slid on,snapped on, clamped on, etc.) and then the distal end of the insertiondevice may be inserted within the nasal cavity to position the sinusdilator within the stenotic opening. In certain embodiments, theretention interface and sinus dilator are configured to be removablycoupled, thus the sinus dilator may be decoupled from the insertiondevice and left within the stenotic opening.

The retention interface may include various coupling mechanisms toretain the sinus dilator coupled to the insertion device. In someinstances, the retention interface is sized and shaped to fit within asinus dilator, e.g., within the central passageway of the sinus dilator,or a passageway, recess, slot, etc. within the sinus dilator. Theretention interface may provide sufficient retention to maintain thesinus dilator coupled while permitting some light axial and off-axisloads or bending moments. In some instances, the sinus dilator issufficiently rigidly affixed to the retention interface to enable a user(e.g., physician) to push the sinus dilator through a stenotic openingeven when the opening is completely shut.

As summarized above, the insertion device also includes a handheldmember. As the handheld member is held by the user, it is configured tohave a shape and size that is amenable to gripping by the user's hand.The insertion device may include, for example, a trigger that is locatedin a position for the user to actuate the trigger in order to decouple asinus dilator coupled to the distal end of the insertion device. Forinstance, the insertion device may be shaped and sized to be gripped bya physician's hand with the trigger accessible to the user's hand whilegripping the handheld member, e.g., actuated by the physician's thumb,actuated by a user's index finger (for instance, with a gun-liketrigger), etc. The trigger may, for example, be configured to couple tothe interior elongated member or hollow elongated member. It should beappreciated that an electrical circuit can be created to actuate themechanical translation of the interior elongated member or hollowelongated member.

Upon activation of the trigger, the retention interface is decoupledfrom the sinus dilator. For example, the interior elongated member maybe relatively displaced with respect to the hollow elongated member. Insome embodiments, the relative displacing of the interior elongatedmember with respect to the hollow elongated member includes proximallydisplacing the retention interface within the hollow elongated memberwhile the hollow elongated member remains in a substantially fixedposition relative to the handheld member. For example, the actuation ofthe trigger may cause the retention interface to displace such that atleast a portion of the retention interface that is outside of the distalend of the hollow elongated member is displaced proximally within thehollow elongated member. In some instances, the distal tip of the hollowelongated member may provide a stop against which the sinus dilator ispulled against as all or part of the retention interface is displacedproximally within the hollow elongated member. In some cases, actuationof trigger in the embodiments described above decouples the sinusdilator from the insertion device as the retention interface isdisplaced proximally with respect to the hollow elongated member.

In other embodiments, the relative displacing of the interior elongatedmember with respect to the hollow elongated member includes distallydisplacing the retention interface within the hollow elongated memberwhile the hollow elongated member remains in a substantially fixedposition relative to the handheld member. For example, the actuation ofthe trigger may cause the retention interface to displace such that atleast a portion of the retention interface that is inside of the distalend of the hollow elongated member is displaced distally within thehollow elongated member. In some instances, the distal tip of theinterior elongated member may push against the sinus dilator as theretention interface is displaced distally within the hollow elongatedmember. In some cases, actuation of the trigger in the embodimentsdescribed above decouples the sinus dilator from the insertion device asthe distal tip of the interior elongated member is displaced distallywith respect to the hollow elongated member.

The overall weight of the insertion device may take into accountusability as a handheld device by the user, e.g., to permit a physicianto easily hold and handle the device during an insertion procedure. Theshape of the handheld member may vary, but in some instances may be inthe shape of a wand with a button or switch trigger, a gun-like handleand trigger, or other graspable and usable shape.

As summarized above, the insertion device is dimensioned such that atleast the distal end of the device can pass through the nasal cavity ofa subject. The distal end may include, for example, at least a portionof the hollow elongated member, interior elongated member and retentioninterface. As such, at least the distal end of the device has across-sectional diameter that is 10 mm or less, such as 8 mm or less,and including 5 mm or less. The elongated members may have the sameouter cross-sectional dimensions (e.g., diameter) along its entirelength. Alternatively, the cross-sectional diameter may vary along thelength of the elongated members.

Furthermore, the lengths of the hollow elongated member and interiorelongated member may vary. For example, the lengths of the elongatedmembers may vary depending on the specific sinus being targeted. In someinstances, the lengths of the elongated members range from 1 cm to 20cm, such as 2 cm to 15 cm, including 5 cm to 10 cm. It should beappreciated that in some instances the hollow elongated member andinterior elongated member may have different lengths from one another.

As stated above, the hollow elongated member and interior elongatedmember of the insertion device has a proximal end and a distal end. Theterm “proximal end”, as used herein, refers to the end of the elongatedmembers (or the insertion device or other component on the insertiondevice) that are nearer the user (such as a physician operating thedevice in an insertion procedure), and the term “distal end”, as usedherein, refers to the end of the elongated members (or the insertiondevice or other component on the insertion device) that are nearer thetarget stenotic opening of the subject during use.

The hollow elongated members may be, for example, a structure ofsufficient rigidity to allow the distal end to be pushed through tissuewhen sufficient force is applied to the proximal end of the device. Assuch, in some embodiments, the elongated member is not pliant orflexible, at least not to any significant extent. Example materials mayinclude, but are not limited to, metals, metal alloys (e.g., stainlesssteel), polymers such as hard plastics, etc.

In some embodiments, the hollow elongated member includes a curved tipsection at its distal end. The curvature and length of curvature mayvary in degree, and may vary according to application, such as withwhich sinus opening is being accessed, e.g., maxillary sinus, frontalsinus, sphenoid sinus, etc. In some embodiments, to facilitate access toan opening of the maxillary sinus, the curved tip section is configuredto bend at an angle ranging from 0° to 150°, such as 10° to 130°,including 20° to 120°, or 30° to 120°, or 60° to 120°, or 90° to 120°,or 100° to 120°, or 105° to 115° from the axis of the non-curved portionof hollow elongated member. In some embodiments, the curved tip sectionis configured to bend at an angle ranging from 105° to 115°, such as110°, from the axis of the non-curved portion of hollow elongatedmember. In some cases, the length of the curved tip section (e.g., thearc length of the curved tip section) is 5 cm or less, such as 3 cm orless, including 2 cm or less, or 1 cm or less, or 0.5 cm or less. Assuch, in the above embodiments, when the sinus dilator is coupled to theinsertion device, the sinus dilator may be positioned at an anglerelative to the hollow elongated member of the insertion device. Forinstance, the longitudinal axis of the sinus dilator may be at an anglerelative to the longitudinal axis of the hollow elongated member. Theangle may be in the ranges and values described above.

The interior elongated member may be, in some instances, a structure ofsufficient rigidity to allow the sinus dilator to be pushed through thestenotic opening when sufficient force is applied to the proximal end ofthe device, even when the stenotic opening is completely occluded. Insome instances, the interior elongated member may be a metal, metalalloy, polymer (hard or pliant and flexible), etc. Further, the interiorelongated member is, in some instances, a structure sufficiently pliantand flexible such that the interior elongated member may be relativelydisplaced in a hollow elongated member having a curved tip section.Examples of sufficiently pliant and flexible materials may include, butare not limited to, polymers such as plastics, rubber-like polymers,flexible metal (e.g., flexible wire), etc. In such cases, the hollowelongated member may provide the rigidity necessary to push the sinusdilator through the stenotic opening with sufficient force applied tothe proximal end of the device.

As summarized above, the interior elongated member may include aretention interface adapted to removably couple to the sinus dilator.For example, the retention interface may be configured to mate with(e.g., slide within), clamp on, or removably couple in another way with,the sinus dilator. In some instances, the retention interface is part ofthe interior elongated member in that the retention interface andinterior elongated member are parts of a single unitary piece ofmaterial. In other instances, the retention interface may be a separatepiece of material that is coupled to the interior elongated member,either removably or non-removably coupled in different embodiments.Retention interfaces that are removably coupled to the interiorelongated member may provide the ability to replace retention interfaces(e.g., for sanitation purposes, or replacement purposes) or switch todifferent types of retention interfaces (e.g., for use with differenttypes or sized sinus dilators).

In some embodiments, the retention interface is adapted to fit within acentral passageway of the sinus dilator. The sinus dilator may be, forexample, shaped and sized to fit within the contours of the centralpassageway of the sinus dilator. The sinus dilator may then be coupledto the retention interface by sliding the sinus dilator onto theretention interface. In some instance, the shape and size of theretention interface matches the contours of the central passageway ofthe sinus dilator. Also, in some instances, the interior elongatedmember may be slid all the way through the central passageway of thesinus dilator with a tip portion extending out of the sinus dilator.

In some aspects, the insertion device is configured to stop the sinusdilator when it is completely slid onto the retention interface so thatthe dilator cannot continue to slide down the retention interface andinterior elongated member. In some instances, the retention interface isshaped to stop the sinus dilator when completely slid on the retentioninterface, e.g., shaped to include stops. For example, the retentioninterface may be shaped with a decreasing cross-sectional width closerto the tip. Since the retention interface is shaped and sized to fitwith the interior surface of the central passageway of sinus dilator,the retention interface may be adapted to abut one or more contactsurfaces on the sinus dilator, acting as stops for the sinus dilatorwhen completely inserted on the retention interface. Thus, the stopsprevent the sinus dilator from being inserted further once the stops areencountered. The stops may provide addition support when force isapplied from the proximal end of the insertion device in order to pushthe sinus dilator through tissue and a stenotic opening. Furthermore,such stops do not inhibit movement of the retention interface in theopposite direction back out the central passageway of the sinus dilator,to allow for decoupling of the retention interface and the sinusdilator. In some instances, the interior elongated member has a widercross sectional width than the retention interface such that the widercross sectional width functions as a stop against a correspondingcontacting surface on the sinus dilator. In some instances, the sinusdilator may abut the hollow elongated member when inserted completely onthe retention interface. The hollow elongated member may, in such case,function as a stop in place of, or in addition to, any stops provided onthe retention interface or interior elongated member.

In some embodiments, the retention interface includes retaining elementsthat provide an additional securing force to the sinus dilator so thatit may not slide back off the retention interface unless a sufficientamount of force is applied to overcome the additional securing force, oruntil the additional securing force is removed. For example, theretention interface may be adapted to provide an outward force on thecentral passageway of the sinus dilator, thus providing an outward forceon the central passageway which helps retain the sinus dilator coupledto the retention interface. The retention interface may, for instance,include a compressible lip, bump, or other protrusion that is compressedwhen inserted within the central passageway of the sinus dilator,providing the outward force on the central passageway. Other retainingelements may also be used, e.g., lips, bumps or protrusion that fitwithin mating recesses on the sinus dilator that “snap” the dilator ontothe retention interface. In some instances, the distal tip of theretention interface is split (e.g., in a polymer flexure design), witheach arm of the split tip stressed or flexed inward towards one anotherwhen inserted within the central passage way of the sinus dilator. Insuch case, for example, the arms of the split tip have a tendency toreturn to their unstressed or not flexed position, thus providing theoutward force to the interior of the central passageway of the sinusdilator.

Sufficient force to overcome the additional securing force by theretaining elements may be provided by, for example, withdrawing theinterior elongated member while the sinus dilator is securely fit withinthe stenotic opening. As another example, the sufficient force may beprovided by the hollow elongated member being displaced and pushed intothe sinus dilator to push the sinus dilator off the retention interface.

Additionally, the distal tip of the retention interface, whether splitor not, may include a small lip, bump, or other protrusion thatfunctions as a retaining element to provide the additional securingforce necessary to resist the sinus dilator from moving back off theretention interface. It should be appreciated that the size and shape ofthe protrusions will determine the amount of sufficient force necessaryto overcome the additional securing force provided by the protrusions.

It should also be appreciated that the above described retainingelements are exemplary and that other types of retaining elements may beimplemented. It should also be appreciated that the retaining elementdescribed above, and equivalents thereof, serve as means for providingan additional securing force to the sinus dilator when inserted on theretention interface.

In some embodiments, the insertion device may include a lumen thatextends to the distal end of the insertion device. For example, thelumen may extend within the interior elongated member and include anopening at the distal tip of the elongated member. It should beappreciated that the lumen may, in some instances, be formed by theinterior elongated member or formed by a tube positioned within theinterior elongated member. In alternative embodiments, the lumen may bepositioned within the hollow elongated member but not within theinterior elongated member.

In some instances, insertion device is configured to couple the lumen toa fluid source to dispense fluid into the sinus cavity or nasal cavitybefore, during or after placement of the sinus dilator in the stenoticopening. The term “fluid” is used herein generally to refer to anyvariety of fluids, mists, gels, single or multi-phase liquid, etc., orcombinations thereof. The fluid source may be located in variouspositions, depending on design, e.g., being located on or in the device,attaching to the device (e.g., a cartridge, etc.), or coupling to thedevice via a connection port, etc. In some instances, the lumen iscoupled to a hollow tube in the handheld member that brings the lumen influid communication with the fluid source. Example fluids that may bedispensed are, for example, fluids comprising water, saline solution,drugs, etc. Example drugs that may be present in the fluid (e.g., influid or solid form) may include, but are not limited to fluidscomprising one or more analgesics, anesthetics, anti-inflammatories,antibiotics, steroids, drugs that control or limit bleeding (e.g.,vasoconstrictors), etc.). Vasoconstrictors may include, for example,oxymetazoline, epinephrine, tranexamic acid, salts thereof, combinationsthereof, and the like.

In some embodiments, the lumen may be coupled to a pellet source orother source of solid, such as powder, etc. In such case, the lumen isused to dispense solid pellets, for example, into the sinus cavityand/or nasal cavity before, during or after placement of the sinusdilator in the stenotic opening. Furthermore, in some instances, thelumen may be coupled to a suction source (e.g., vacuum source) in orderto provide suctioning, in order to remove fluid, tissue debris, etc. Itshould be appreciated that in some instances more than one lumen may beimplemented. For example, in some instances, one lumen may be providedto dispense fluids while another lumen is provided for suctioningpurposes.

In some embodiments, the insertion device may be configured to include acamera positioned near the distal end of the hollow elongated member inorder to assist in visualizing the stenotic site, nasal cavity, or sinuscavity. In some instances, the camera may be positioned on the exteriorsurface of the hollow elongated member and, for example, electricallycoupled to a monitor via an electrical wire extending along or withinthe hollow elongated member. In other instances, the camera may bepositioned within the hollow elongated member. For example, a camera maybe positioned at the tip of the interior elongated member andelectrically coupled to a monitor via an electrical wire extendingwithin the interior elongated member.

The insertion device, or components thereof, may be configured for onetime use (i.e., disposable) or may be re-usable, e.g., where thecomponents are configured to be used two or more times before disposal,e.g., where the device components are sterilizable.

Additional aspects of the insertion devices and methods for use aredescribed in more detail in U.S. patent application Ser. Nos. 13/219,505and 13/219,497, both filed Aug. 26, 2011, the disclosures of each ofwhich are incorporated herein by reference.

Additional Aspects of the Sinus Dilator and Insertion Device

Referring now to FIG. 1, there is shown a human patient 10 having twofrontal sinuses (FS) and two maxillary sinuses (MS). Each of these foursinuses has an opening which can be accessed by way of the patient'snostrils. The openings include maxillary sinus openings 11 and 12, ofwhich opening 11 is shown in a normal open condition and opening 12shown in an occluded or stenotic condition. Similarly, the patient 10has frontal sinus openings 13 and 14, of which opening 14 is shown in anormal open condition and opening 13 is shown in an occluded or stenoticcondition.

Referring now to FIG. 2, there is shown a sectional view of a patient'snose and sinuses including the nasal cavity (NC), the nasopharynx (NP),the nostril opening (NO), the frontal sinus (FS), the sphenoid sinus(SS) and the sphenoid sinus opening (SSO).

Additional aspects of the sinus dilator and the insertion device willnow be described in more detail in the following sections.

In Situ Osmotic Anchor

In certain embodiments, the sinus dilator includes two drivers, such asa first driver and a second driver. The first driver may be positionedproximal to the second driver, such that the second driver is positionedcloser to the distal end of the sinus dilator than the first driver(e.g., the first driver may be termed the “proximal driver” and thesecond driver may be termed the “distal driver”). In certainembodiments, the first and second drivers are self-expanding drivers,such as self-expanding osmotic drivers. As such, the first and seconddrivers may include an osmotically active agent and an osmopolymer.

In certain embodiments, the second driver is configured to have a fasterrate of expansion than a rate of expansion of the first driver. In someinstances, the second driver is configured to have a duration ofexpansion less than a duration of expansion of the first driver. Asecond driver configured as described above, may facilitate theprevention of the device from being squeezed out of the stenotic openingand into the nasal cavity during device expansion.

In some instances, the first and second drivers have differentcompositions of the osmotically active agent and/or the osmopolymer. Forexample, the first and second drivers may have different concentrationsof the osmotically active agent (or different osmotically activeagents). In some cases, the first and second drivers may have differentconcentrations of the osmopolymer (or different osmopolymers). A sinusdilator that has different first and second driver compositions mayfacilitate retention of the sinus dilator in the stenotic opening duringuse. For example, the device may be retained in the stenotic openingsuch that the sinus dilator is not expelled out of the stenotic openingand into the nasal cavity during device expansion.

For example, in embodiments where the first and second drivers includethe same osmotically active agent, the second driver (e.g., distaldriver) may include a greater concentration of osmotically active agentthan the first driver (e.g., proximal driver). Inclusion of a greaterconcentration of osmotically active agent in the second driver may causethe second driver to expand at a greater rate than the first driver. Insome instances, if the second driver includes a greater concentration ofosmotically active agent than the first driver, the second driver alsoincludes a lower amount of osmopolymer than the first driver. In certainembodiments, the relatively high osmotically active agent concentrationand relatively low osmopolymer amount of the second driver relative tothe first driver causes the second driver to expand more rapidly thanthe first driver (e.g., due to the higher osmotically active agentconcentration), and after expansion causes the second driver to collapseback down in size more rapidly than the first driver (e.g., because thesecond driver has less osmopolymer to keep it fully expanded). In theseembodiments, the second driver expands more rapidly than the firstdriver, and thus anchors the sinus dilator in the stenotic opening(e.g., prevents the sinus dilator from being expelled into the nasalcavity). In some cases, the duration of expansion of the second driveris less than that of the first driver, such that the anchoring effect ofthe second driver is temporary. In these embodiments, the sinus dilatormay be more easily removed after the second driver has decreased in sizerelative to its fully expanded configuration.

Thus, in certain embodiments, the second driver is configured to have(i) a faster rate of expansion than a rate of expansion of the firstdriver, and (ii) a duration of expansion less than a duration ofexpansion of the first driver, whereby the second driver prevents thedevice from being expelled out of the stenotic opening and into thenasal cavity during device expansion.

In certain embodiments, the second driver is configured to have aduration of expansion of 8 hours or less, such as 6 hours or less, or 4hours or less, or 2 hours or less, or 1 hour or less, or 0.5 hours orless. In some cases, the second driver is configured to have a durationof expansion of 2 hours or less. In certain embodiments, the first andsecond drivers are configured such that the duration of expansion of thesecond driver ranges from 0.5 to 12 hours less than the duration ofexpansion of the first driver, such as 0.5 hours to 10 hours less,including 0.5 hours to 8 hours less, or 0.5 hours to 6 hours less, or0.5 hours to 4 hours less, or 1 hours to 4 hours less than the durationof expansion of the first driver.

As described above, the second driver may expand at a greater rate thanthe first driver, but may not stay in a fully expanded configuration foras long as the first driver. In certain embodiments, the second driveris configured to have a diameter greater than the diameter of the firstdriver during a period of stenotic opening dilation, and the seconddriver is configured to have a diameter less than the diameter of thefirst driver following said period of stenotic opening dilation. Forexample, the period of stenotic opening dilation may be 0.5 hours ormore, such as 1 hour or more, including 1.5 hours or more, or 2 hours ormore. In some cases, the period of stenotic opening dilation is 0.5hours or more. In some instances, the period of stenotic openingdilation is 2 hours or less, such as 1.5 hours or less, or 1 hour orless, including 0.5 hours or less. For example, the period of stenoticopening dilation may be 2 hours or less.

In certain embodiments, each of the first and second drivers includes anosmotically active agent, the second driver having a concentration ofthe osmotically active agent that is greater than that in the firstdriver. In some cases, the osmotically active agent in the second driverhas a concentration of 50 to 90 wt %, such as 50 to 80 wt %, including50 to 70 wt %. In some instances, the osmotically active agent in thefirst driver has a concentration of 10 to 50 wt %, such as 20 to 50 wt%, including 30 to 50 wt %. In certain cases, the osmotically activeagent in the second driver has a concentration of 50 to 70 wt % and theosmotically active agent in the first driver has a concentration of 30to 50 wt %.

In certain embodiments, each of the first and second drivers includes anosmopolymer, the second driver having a concentration of the osmopolymerthat is less than that in the first driver. In some cases, theosmopolymer in the first driver has a concentration of 30 to 70 wt %,such as 30 to 80 wt %, including 30 to 90 wt %. In certain instances,the osmopolymer in the second driver has a concentration of 10 to 50 wt%, such as 20 to 50 wt %, including 30 to 50 wt %. In some cases, theosmopolymer in the first driver has a concentration of 30 to 70 wt % andthe osmopolymer in the second driver has a concentration of 20 to 50 wt%.

In some aspects, an osmotic driver element is designed to operate inconcert with a mechanical proximal anchor to anchor a sinus dilatorwithin a sinus opening during dilation. As illustrated in FIGS. 5 and 7,the dilators 100 and 120 each have a pair of annularly shaped osmotictablets 103, 104 positioned side-by-side in direct contact with oneanother, and which are both completely enclosed within the elasticsemipermeable membrane 105. The compositions of the osmotic tablets areselected such that when the membrane 105 is exposed to aqueous bodyfluids, one of the osmotic tablets 103, 104 imbibes water across thesemipermeable membrane 105 causing it to radially expand at a differentrate than the adjoining osmotic tablet. The osmotic tablet 104 locatedcloser to the proximal end of the device 100 is formulated to have aslower radial expansion rate than the osmotic tablet 103 positionedcloser to the distal end of the device 100 by selecting the osmoticcomposition within the tablets 103, 104 to be different from each other.Typically, the tablets 103, 104 are formulated primarily with an osmoticagent (e.g., a water soluble salt such as NaCl) and an osmopolymer, suchas a hydrogel-forming osmopolymer (e.g., an osmopolymer that forms ahydrogel when exposed to water). In this aspect, the proximal tablet 104is made with a lower osmotic agent content and a higher hydrogel polymercontent than the distal tablet 103. For example, the proximal tablet 104may contain from 35 to 65 wt % osmotic agent and 30 to 60 wt %osmopolymer; and the distal tablet 103 may contain from 45 to 75 wt %osmotic agent and 20 to 50 wt % osmopolymer. The net effect of thiscompositional difference is to create in situ a tapered shape of osmoticdriver 110 as the driver expands. The tapered shape results from thedistal tablet 103 imbibing water more quickly than proximal tablet 104and thereby expanding to a larger diameter than the diameter of theproximal tablet 104. In the case of a maxillary sinus dilation, thelength of the maxillary sinus opening 11 (length is the distance fromthe nasal passageway side to the maxillary sinus cavity side) istypically about 1 to 3 mm. Since the length of the sinus opening is muchless than the combined length of the tablets 103, 104, at least aportion of the distal tablet 103 is positioned within the sinus cavity(MS) during use. The resulting expansion of tablets 103, 104 forms awedge with the larger diameter tablet 103 being positioned within thesinus cavity (MS) while the smaller diameter tablet 104 is within thesinus opening 11. The resulting wedge shape helps prevent the device 100from being squeezed out of the sinus opening 11 and into the nasalpassageway 15 during dilation. During dilation, as the tablets 103, 104expand radially outwardly, the tapered configuration of the membranecauses the dilator 100 to be forced in the opposite direction to thedirectional force exerted by the proximal mechanical anchor 107. The twoopposing forces thereby retain the dilator 100 within the sinus opening11. This differential swelling is achieved by selecting theconcentration of osmotic agent within the distal tablet 103 to be atleast 10% greater than the concentration of osmotic agent in theproximal tablet 104.

Wicking Agent

In certain embodiments, the osmotic driver of the sinus dilator includesa wicking agent. In some cases, the wicking agent is configured toincrease the rate of expansion of the osmotic driver, as compared to asinus dilator that does not include a wicking agent. For example, thewicking agent may absorb fluid from the surrounding environment ortissues during use of the sinus dilator. As such, in certain instances,the wicking agent is configured to decrease the amount of time for thesinus dilator to expand from the non-expanded configuration to theexpanded configuration, as compared to a sinus dilator that does notinclude a wicking agent.

In certain embodiments, the wicking agent includes an absorbentcompound. In some cases, the wicking agent includes hydroxypropylcellulose; chemically cross-linked organic polymers, such ascross-linked sodium carboxymethyl cellulose, cross-linked polyvinylpyrrolidone; physically cross-linked organic polymers, such asmicrocrystalline cellulose and powdered cellulose; inorganic swellingagents, such as bentonite clay; combinations thereof; and the like. Incertain instances, the wicking agent includes hydroxypropyl cellulose.

In some embodiments, the wicking agent has an average particle size of1000 μm or less, such as 750 μm or less, including 500 μm or less, or250 μm or less, or 100 μm or less, or 50 μm or less, or 25 μm or less,or 10 μm or less, or 1 μm or less. In some cases, the wicking agent hasan average particle size of 50 μm or less.

In accordance with another aspect, a wicking agent can be incorporatedinto the osmotic tablets 103, 104 of the sinus dilator 100 to promotewater transmission across the membrane 105 and enhance the rate ofexpansion of osmotic driver 110. The use of a wicking agent isparticularly useful for short term dilations (e.g., dilation times of upto about 2 hours duration), e.g., where the patient does not leave thedoctor's office while the device 100 is in use. The wicking agentfunctions by capillary action to conduct water that has passed throughthe membrane 105 and into the osmotic tablet 103, 104. In certainembodiments, the tablets 103, 104 contain from 10 to 50 wt % of thewicking agent. In other embodiments, the tablets 103, 104 contain from15 to 30 wt % of the wicking agent. In one embodiment, the wicking agentis micronized (˜300 mesh) low (11%) substituted hydroxypropyl cellulose(L-HPC 31) supplied by Shin-Etsu Chemical Co., Ltd., Tokyo, Japan. Othersuitable wicking agents include chemically cross-linked organicpolymers, such as cross-linked sodium carboxymethyl cellulose(Ac-di-Sol; FMC Corp., Philadelphia, Pa.), and cross-linked polyvinylpyrrolidone (PVP-XL; International Specialty Products, Wayne, N.J.);physically cross-linked organic polymers, microcrystalline cellulose(FMC Corp., Philadelphia, Pa.), and powdered cellulose (Solka-Floc;International Fiber Corp., North Tonawanda, N.Y.), inorganic swellingagents, such as bentonite clay; combinations thereof; and the like.

Insertion Device Circumferential Trigger

As described above, an insertion device for a sinus dilator may includea trigger, where actuation of the trigger decouples the sinus dilatorcoupled to the distal end of the insertion device. In certainembodiments, the trigger is configured to be accessible to the user fromany gripping position as the user holds the insertion device during use.For example, the insertion device may be rotated about its longitudinalaxis to any angle relative to the user's hand, and the trigger may bemaintained in a convenient position for actuation by the user. In somecases, to facilitate actuation of the trigger from any hand position asdescribed above, the insertion device includes a trigger that extendsaround the exterior surface of the handle of the insertion device. Forinstance, the trigger may extend around 25% or more of the exteriorsurface of the handle, such as 50% or more, or 75% or more. In somecases, the trigger extends substantially entirely around the exteriorsurface of the handle. For example, the trigger may extend completelyaround the circumference of the exterior surface of the handle. As such,the insertion device may be rotated about its longitudinal axis to anyangle relative to the user's hand, and the trigger will be in aconvenient position for actuation by the user.

Aspects of the insertion device include a handheld member including (i)a handle sized to be grasped by a user's hand and having a grippableexterior surface; and (ii) a trigger activated by a user's thumb orfinger. A hollow elongated member is coupled at its proximal end to thehandheld member. The hollow elongated member has a distal end having anopening to an interior cavity of the hollow elongated member and aretention interface for removably coupling to a sinus dilator. Thedevice includes an interior elongated member extending within theinterior cavity of the hollow elongated member and operatively connectedto the trigger.

In certain embodiments, the trigger extends around 25% or more of theexterior surface of the handle, such as 50% or more of the exteriorsurface of the handle, including 75% or more of the exterior surface ofthe handle, or around the entire exterior surface of the handle. In somecases, the handle has a circular cross-section and the trigger extendsaround a percentage of a circumference of the handle, such as 25% of thecircumference of the handle, including 50% of the circumference of thehandle, or 75% of the circumference of the handle, or around the entirecircumference of the handle.

In accordance with another aspect, and as shown in FIGS. 10 and 12 to16, the insertion device 200 has a trigger 203 that extends around theentire circumference of handle 202. While device 200 has a handle 202with a circular cross section, those skilled in the art will appreciatethat handle 202 can have other cross sectional shapes, including oval,square, etc. The advantage of trigger 203 is that the device 200 can begripped from any side and the trigger 203 will be conveniently locatedfor actuation by the user's thumb or finger. While trigger 203 is shownas extending completely around the exterior surface of the handle 202,other embodiments of trigger can extend over a lesser portion of thatcircumference. In certain embodiments, the trigger 203 can extend around25% or more of the outer surface of handle 202. In other embodiments,the trigger 203 can extend around 50% or more of the outer surface ofhandle 202. In other embodiments, the trigger 203 can extend around 75%or more of the outer surface of handle 202.

Insertion Device with Low Profile Tip

In some embodiments, the insertion device is configured to facilitateinsertion of a sinus dilator into a stenotic opening in a subject. Forexample, the insertion device (e.g., the distal end of the insertiondevice) may be sized to fit within the nasal cavity of a subject. Asdescribed above, the sinus dilator may be positioned at an anglerelative to the hollow elongated member of the insertion device (e.g.,at an angle ranging from 105° to 115°, such as 110°). As such, theinsertion device may be configured to minimize the overall width of thedevice during use. For instance, the distance (h) between the distal tipof the sinus dilator and the opposite outer surface of the hollowelongated member of the insertion device (see FIG. 19) may be minimizedto facilitate insertion of the sinus dilator in the nasal cavity of asubject.

As described above, the insertion device includes a handheld memberincluding a handle and a trigger. The insertion device also includes ahollow elongated member having a proximal end coupled to the handheldmember. As described above, in certain embodiments, the insertion devicealso includes an interior elongated member coupled to the trigger andextending within a central passageway of the hollow elongated member.

In certain embodiments, the hollow elongated member is coupled at itsdistal end to a retention tip. The retention tip may be configured toremovably couple to a sinus dilator, as described in more detail below.In certain embodiments, the retention tip includes an interior cavity,such as a central passageway. The central passageway of the retentiontip may be in fluid communication with the central passageway of thehollow elongated member. In some instances, the retention tip includesan opening to the central passageway of the hollow elongated member. Assuch, the central passageway of the hollow elongated member may be influid communication with the central passageway of the retention tip.

In certain embodiments, the retention tip is angularly coupled to thedistal end of the hollow elongated member with respect to the centralpassageway of the hollow elongated member. In these embodiments, thecentral passageway of the retention tip is non-collinearly aligned withthe distal end of the hollow elongated member. For instance, theretention tip may be coupled to the distal end of the hollow elongatedmember at an angle with respect to a longitudinal axis of the hollowelongated member. In certain cases, the angular coupling between theretention tip and the hollow elongated member is such that thelongitudinal axis of the hollow elongated member is at an angle withrespect to the longitudinal axis of the retention tip. In someinstances, the angular coupling between the hollow elongated member andthe retention tip has an angle that is less than 180°, such that theangle between the longitudinal axis of the hollow elongated member andthe longitudinal axis of the retention tip is less than 180°. Forexample, the angular coupling between the hollow elongated member andthe retention tip may have an angle from 0° to 150°, such as 10° to130°, including 20° to 120°, or 30° to 120°, or 60° to 120°, or 90° to120°, or 100° to 120°, or 105° to 115°. In some embodiments, the angleranges from 105° to 115°, such as 110°.

In embodiments where the retention tip is angularly coupled to thehollow elongated member as described above, the hollow elongated membermay be substantially linear. For example, the distal end of the hollowelongated member may be substantially linear. In certain instances, thedistal end of the hollow elongated member does not include a curved tipsection as described in some of the alternate embodiments describedabove.

In certain embodiments, the retention tip is coupled to the distal endof the hollow elongated member at a position between the proximal anddistal ends of the retention tip. For example, the retention tip may becoupled to the distal end of the hollow elongated member on a side ofthe retention tip. In some instances, the retention tip is not coupledto the distal end of the hollow elongated member at the proximal end ofthe retention tip.

In certain embodiments, to minimize the overall width of the insertiondevice (e.g., the distal end of the insertion device), the retention tiphas a length (e.g., as measured along its longitudinal axis) that is 15mm or less, such as 10 mm or less, including 7 mm or less, or 5 mm orless, or 3 mm or less, or 1 mm or less.

The sinus dilator may be coupled to the retention tip (e.g., slid in,snapped in, clamped, etc.) and then the distal end of the insertiondevice may be inserted within the nasal cavity to position the sinusdilator within the stenotic opening. In certain embodiments, theretention tip and sinus dilator are configured to be removably coupled,thus the sinus dilator may be decoupled from the insertion device andleft within the stenotic opening. The retention tip may include variouscoupling mechanisms to retain the sinus dilator coupled to the insertiondevice. In some instances, the retention tip is sized and shaped to fitaround at least a portion of the proximal end of the sinus dilator, thusretaining the sinus dilator on the insertion device. The retention tipmay provide sufficient retention to maintain the sinus dilator coupledwhile permitting some light axial and off-axis loads or bending moments.In some instances, the sinus dilator is sufficiently rigidly affixed tothe retention tip to enable a user (e.g., physician) to push the sinusdilator through a stenotic opening even when the opening is completelyshut.

As described above, in certain embodiments, the retention tip includesan opening to the central passageway of the hollow elongated member. Assuch, the central passageway of the hollow elongated member is in fluidcommunication with the central passageway of the retention tip. Thedistal end of the retention tip may include an opening configured toaccept the distal end of the sinus dilator, for example to facilitateretention of the sinus dilator on the insertion device. In certainembodiments, the opening between the retention tip and the hollowelongated member is sized to allow passage of the distal end of theinterior elongated member through the opening. In some cases, the distalend of the interior elongated member is configured to extend through theopening in the retention tip into an interior cavity of the retentiontip. In these embodiments, the distal end of the interior elongatedmember may be displaced distally and/or proximally within the openingbetween the retention tip and the hollow elongated member.

In certain embodiments, the distal end of the interior elongated memberis configured to couple to the sinus dilator to facilitate retention ofthe sinus dilator on the insertion device. For example, the distal endof the interior elongated member may include a retention interface, asdescribed in some embodiments above. In certain instances, the retentioninterface is sized and shaped to fit within the sinus dilator, e.g.,within an opening in the sinus dilator, or recess, slot, and the like,for example in the side of the sinus dilator.

Upon activation of the trigger, the sinus dilator may be decoupled fromthe retention tip. For example, the interior elongated member may berelatively displaced with respect to the hollow elongated member. Insome embodiments, the relative displacing of the interior elongatedmember with respect to the hollow elongated member includes proximallydisplacing the retention interface within the hollow elongated memberwhile the hollow elongated member remains in a substantially fixedposition relative to the handheld member. In some cases, the interiorelongated member is configured to decouple from the sinus dilator whenthe interior elongated member is displaced proximally within the hollowelongated member. For example, the actuation of the trigger may causethe retention interface to displace such that at least a portion of theretention interface that was coupled to the distal end of the sinusdilator is displaced proximally within the hollow elongated member. Insome instances, the retention interface is displaced sufficientlyproximally within the hollow elongated member so that the sinus dilatoris able to be decoupled from the insertion device.

In other embodiments, the relative displacing of the interior elongatedmember with respect to the hollow elongated member includes distallydisplacing the interior elongated member within the hollow elongatedmember while the hollow elongated member remains in a substantiallyfixed position relative to the handheld member. In certain instances,the interior elongated member is configured to decouple the sinusdilator from the retention interface when the interior elongated memberis displaced distally within the hollow elongated member. For example,the actuation of the trigger may cause the interior elongated member todisplace such that the distal end of the hollow elongated member isdisplaced distally within the hollow elongated member. In someinstances, the distal end of the interior elongated member may pushagainst the proximal end of the sinus dilator as the interior elongatedmember is displaced distally within the hollow elongated member. In somecases, actuation of the trigger in the embodiments described abovedecouples the sinus dilator from the insertion device as the distal endof the interior elongated member is displaced distally with respect tothe hollow elongated member.

An embodiment of an insertion device that includes a low profile tip asdescribed above is shown, for example, in FIG. 19. For comparison, analternative embodiment is shown in FIG. 9 described herein. In FIG. 9,the bend 206 in the distal tip of the insertion device accommodates themovement of the flexible rod 205 (see e.g., FIG. 14) which pushes thedilator 100 off of the distal end of the insertion device when thedilator is in position within the sinus opening. In certain embodiments,the bend 206 creates a larger height dimension to the distal tip of theinsertion device as compared to an embodiment of an insertion devicethat includes a low profile tip. In certain instances, an insertiondevice that includes a low profile tip facilitates maneuvering thedistal tip of the insertion device, with the dilator 100 mountedthereon, past the nasal turbinates and uncinate to reach a sinus opening(e.g., a maxillary sinus opening) for treatment.

An insertion device with a low profile distal tip is shown in side andsectional views in FIGS. 19 and 21, respectively. As a side-by-sidecomparison, FIG. 20 shows an insertion device with a curved distal tip(see e.g., FIG. 9) with a similar length sinus dilator mounted thereon.In all three of FIGS. 19 through 21, the dilator 100 has a length of13.0 mm and is mounted so that the axis of the dilator 100 is at a 110°angle (θ) with respect to the axis of the hollow elongated member (e.g.,cannula 201) of the insertion device. As shown in FIG. 19, the height(h) of the insertion device tip may be measured from the upper surfaceof the insertion device tip to the end of the distal tip 106 of thesinus dilator 100. As shown in FIG. 20, the height (h′) of the insertiondevice tip is measured from the upper surface of the bend 206 to the endof the distal tip 106 of the sinus dilator 100. With a sinus dilator 100having a length of 13 mm and mounted at an angle (θ) of 110°, theembodiments shown in FIG. 9 and FIG. 20 with the bend 206 have a height(h′) of about 18 mm, whereas the height (h) of the insertion deviceshown in FIGS. 19 and 21 with the low profile insertion tip is about13.5 mm. In certain embodiments, a smaller height of the distal tip ofthe insertion device with mounted sinus dilator 100 facilitatesinsertion of the sinus dilator into the maxillary sinus ostium throughthe nasal passageways and may provide greater flexibility formaneuvering the sinus dilator 100 into the correct orientation forinsertion and deployment thereof in the sinus ostium.

As described above, in certain embodiments as shown in FIGS. 9 and 20, aflexible rod 205 (see e.g., FIG. 14) extends through the cannula 201,including through the bend 206, and abuts against the proximal end ofthe dilator 100. Once the dilator 100 is in position within a sinusopening, the flexible rod 205 is displaced distally by activation of thetrigger 203, thereby pushing the dilator 100 off the tip of theinsertion device. By comparison, in certain embodiments, the release ofthe dilator from the insertion device with a low profile tip may beperformed in a different manner. As shown in FIGS. 19 and 21, a wire (orrod) 207 is coupled to the trigger (not shown) and extends from thedistal tip of the insertion device. The distal end of wire 207 extendsthrough a hole 208 in the proximal end of the dilator 100 and preventsthe dilator 100 from sliding off the distal tip of the insertion deviceuntil the physician operates the trigger to displace the wire 207 in aproximal direction, this withdrawing the wire 207 from the hole 208.Once the wire is withdrawn from the hole 208, the dilator 100 candecouple from the distal end of the insertion device.

Turning now to FIGS. 22 and 23, there is shown an alternate embodimentof a low profile distal tip for insertion device 220. Insertion device220 has a hollow elongated member (e.g., cannula 221) extending from ahandle (not shown) with a trigger. Attached to the distal end of cannula221 is a retention tip 222. As described above, the retention tip 222may be attached to the distal end of the cannula 221 at an angle, suchas at an angle of 110° with respect to the cannula 221. In FIG. 22,insertion device 220 is shown with a sinus dilator 100 mounted thereonwith the proximal end of the dilator 100 extending into an internalcavity 227 of the retention tip 222. The wings of proximal anchor 107extend through slots of a slotted flange 229 on the retention tip 222.Insertion device 220 has a flexible rod 225 extending through thecannula 221. The proximal end of rod 225 is connected to the triggersuch that moving the trigger in a distal or proximal direction causesthe rod 225 to move in a distal or proximal direction, respectively. Thedistal end of rod 225 has a section 226 with a cross-sectional area thatis less than the cross-sectional area of the proximal portion of rod225, resulting in section 226 having an increased flexibility ascompared to the proximal portion of rod 225. The distal end of section226 abuts against the proximal end of dilator 100 when the dilator ismounted on the retention tip 222 of insertion device 220 (see FIG. 22).Once the dilator 100 is positioned for deployment in a sinus ostium, theuser (e.g., physician) moves the trigger in a distal direction, causingthe rod 225 and section 226 to also move in a distal direction. As shownin FIG. 23, the distal displacement of the rod 225 and section 226causes the distal end of section 226 to push the dilator 100 off of theretention tip 222 of the insertion device 220. In certain embodiments,section 226 has sufficient flexibility to bend as the distal end ofsection 226 encounters the walls of internal cavity 227, eventuallypushing the proximal end of dilator 100 out of the internal cavity 227,thus deploying the dilator 100 in a sinus ostium.

Humidity-Regulating Agent

In another aspect, the dilator is osmotically driven. The osmoticdilator is activated and operates by imbibing liquid water from thepatient's body through an elastic semipermeable membrane 105 intoosmotic tablets 103, 104, which osmotic tablets hydrate and expandradially to mechanically remodel the tissue of the sinus opening 11. Theimbibed water can also be in the form of water vapor. Therefore, it isimportant that the device, prior to use in a patient, be stored andpackaged in an environment with sufficiently low moisture to preventpremature imbibition of water in either liquid or vapor form.Conversely, the membrane 105 and osmotic driver 110 require a certainmoisture content to activate properly. If either membrane 105 or osmotictablets 103, 104 are excessively dried during storage, they lose theminimum equilibrium water content necessary for the device to beginexpanding in a timely manner after insertion into a patient. In orderfor the membrane and osmotic engine to function properly, that removedmoisture would first need be replaced. In those instances involving ashorter duration of dilation (e.g., 0.5 to 2 hours), such an equilibriumwater replacement process leads to an unacceptably and prolonged startupperiod. Therefore before use, it is important to store the osmoticdilator 100 within a package wherein the environment is neither too drynor too humid.

Each component of the osmotic driver 110 has associated with it anequilibrium moisture sorption isotherm. For example, in some cases, theosmotic tablet includes polyethylene oxide, which maintains a moisturecontent of about 5 wt % or less when stored in 65% relative humidity orless. If exposed to about 70% relative humidity or greater, the polymerequilibrates to a higher equilibrium moisture content and swellsaccordingly. Therefore, an osmotic driver 110 with polyethylene oxide asan osmotic tablet 103, 104 component will imbibe water and swellprematurely in a package if the air within the package has a relativehumidity of 70% humidity or greater. Components of elastic semipermeablemembrane 105 likewise have equilibrium moisture contents. For example,polyvinyl pyrrolidone grade 12 PF, a hydrophilic polymer added tomembranes to make them more permeable to water, absorbs 25 wt % moisturewhen exposed to relative humidity of 70%. At this relative humidity, thepolymer may absorb excessive moisture to the extent that the polymerbecomes tacky, which may cause the dilator to stick to the packagingmaterial. By contrast, the same polymer stored in lower relativelyhumidity such as 50%, may absorb only 18% moisture and thus issubstantially less tacky.

In certain embodiments, the osmotic dilator 100 is packaged within asealed water-impermeable and water vapor-impermeable package. Suchpackages are typically comprised of a metal foil, or metalized layer ina laminate material. In accordance with some embodiments, the packagecontains a humidity-regulating agent (e.g., a desiccant) which controlsthe relative humidity within the package to within the range of about 30to 50%. This relative humidity range prevents both (i) pre-matureswelling and formation of tackiness, and (ii) excessive lag time duringthe onset of swelling when dilator 100 is first inserted into a sinusopening of a patient.

In certain embodiments, the humidity-regulating agent is an osmoticsalt. Osmotic salts have the properties of maintaining a constantrelative humidity when present in a sachet or canister of a desiccantpack stored in a closed space, such as in a product package. Theseosmotic salts function by establishing an equilibrium exchange ofmoisture between the water vapor within the headspace of the package andsaturated solution on the surface of the osmotic salt which is presentin excess as a solid within the desiccant pack. The humidity-regulatingagent (e.g., osmotic salt) can be configured to achieve a controlledhumidity environment for storage of an osmotic dilator. For example,magnesium chloride maintains a constant relative humidity of about 33 to31% over a typical storage temperature range of 20 to 37° C. Likewise,potassium carbonate maintains a constant relative humidity of 44 to 41%over a temperature range of 20 to 37° C. Such humidity-regulating agents(e.g., osmotic salts) can be used as desiccants to control and maintainrelative humidity within the package of an osmotic dilator 100 tomaintain the relative humidity within the desired range.

Aspects of the present disclosure include a kit including a device fordilating a stenotic opening of a paranasal sinus in a subject. The kitincludes the device and a sealed package containing the device. Thedevice includes an expandable portion configured to expand from anon-expanded configuration to an expanded configuration. Thenon-expanded configuration is sized to be positioned within the stenoticopening. The device also includes a self-expanding osmotic driverconfigured to expand the expandable portion from the non-expandedconfiguration to the expanded configuration, wherein the expandedconfiguration dilates the stenotic opening. The sealed package is waterimpermeable and contains a humidity-regulating agent.

In certain embodiments, the osmotic driver includes a semipermeablemembrane that includes a hydrophilic polymer having an equilibrium watercontent range. The humidity-regulating agent may be configured tomaintain the water content of the hydrophilic polymer within theequilibrium water content range. In some instances, the osmotic driverincludes an expandable osmotic core that expands upon exposure to water.The humidity-regulating agent may be configured to prevent the osmoticcore from expanding while in the sealed package.

In certain embodiments, the humidity-regulating agent is configured tomaintain the relative humidity within the sealed package at a relativehumidity of from 10% to 90%, such as from 20% to 80%, including from 20%to 70%, or from 20% to 60%, or from 30% to 60%, or from 30% to 50%, orfrom 30% to 40%. In some cases, the humidity-regulating agent isconfigured to maintain the relative humidity within the sealed packageat a relative humidity of from 30% to 50%.

Sinus Dilator Proximal Anchor

In certain embodiments, the proximal anchor of the sinus dilator isconfigured to have a size (e.g., length) such that during placement ofthe device in the maxillary sinus, the proximal end of the devicecontacts the opposing wall of the nasal cavity facing the sinus ostium.In some instances, the proximal end of the proximal anchor contacts theopposing wall of the nasal cavity facing the sinus ostium. In somecases, the proximal end of the device (e.g., the proximal end of amounting member at the proximal end of the device) contacts the opposingwall of the nasal cavity facing the sinus ostium. As such, the proximalend of the device may be an elongated proximal end. In some instances,the elongated proximal end prevents the device from being squeezed outof the sinus opening and into the nasal passageway during deviceexpansion of the device. A device configured in such a manner mayfacilitate a sinus dilator that does not include a distal anchor (e.g.,the distal anchor being the anchor positioned inside the sinus cavity).In some instances, the proximal end of the device may not directlycontact the opposing wall of the nasal cavity facing the sinus ostium.In these embodiments, a packing material may be positioned between theproximal end of the device and the opposing wall of the nasal cavitysuch that the device indirectly contacts the opposing wall of the nasalcavity. In some instances, a sinus dilator that does not include adistal anchor may facilitate embodiments where the sinus dilator isinserted into the patient for a short period of time (e.g., 8 hours orless, or 6 hours or less, or 4 hours or less, or 2 hours or less).

In one aspect, a device for dilating a stenotic opening of a maxillarysinus in a subject is provided. In certain embodiments, the device has aself-expanding driver configured to expand an expandable portion from anon-expanded configuration to an expanded configuration. In some cases,the expandable portion is disposed peripherally around the driver andconfigured to expand from the non-expanded configuration to the expandedconfiguration, where the non-expanded configuration is sized to bepositioned within the stenotic opening. In certain instances, the devicealso has a proximal anchor proximate to the proximal end of the device,the proximal anchor being sized and configured to prevent the devicefrom passing through the stenotic opening into the maxillary sinuscavity.

In some cases, the device has an elongated proximal end with a lengthsuch that at least a portion of the proximal end of the device contactsa wall of the nasal cavity facing the stenotic maxillary sinus opening.In certain embodiments, the proximal end of the device is sized to fitbetween the sinus opening and the opposing wall of the nasal cavity(e.g., the nasal passageway). As such, in some cases, the device has alength, measured from a point on the device that is immediately adjacentto the nasal passageway side of the sinus opening, to the proximal endof the device, which approximates the distance between the sinus openingand the opposing wall of the nasal cavity in a subject. For example, thelength of that portion of the device which extends from the nasalpassageway side of the sinus opening to the opposing wall of the nasalcavity of a subject, may have a length d (see FIG. 5), measured from apoint on the device that is immediately adjacent to the nasal passagewayside of the sinus opening, to the proximal end of the device, of 1 to 10mm, such as 2 to 7 mm, including 3 to 6 mm, or 3 to 5 mm. In certaincases, the device has a length, measured from a point on the device thatis immediately adjacent to the nasal passageway side of the sinusopening, to the proximal end of the device, of 3 to 6 mm. In someinstances, the elongated proximal end of the device forms at least aportion of the proximal anchor and when wedged against the opposing wallof the nasal cavity keeps the expanding device from being squeezed outof the sinus opening and into the nasal cavity as shown in FIG. 18.

In certain embodiments, the proximal anchor includes a member extendingradially outward from an axis (e.g., a longitudinal axis) of the device.The member may be configured to anchor the device in the stenoticopening and to prevent the device from entering further into the sinuscavity of the subject. In some cases, the member of the proximal anchorprevents the device from entering entirely into the sinus cavity of thesubject, thus positioning the device within the stenotic opening of thesubject during use.

In some instances, the proximal anchor includes one or more members asdescribed above, such as 2 members, 3 members, 4 members, 5 members, 6members, 7 members, 8 members, 9 members, or 10 members. In certaincases, the proximal anchor includes a pair (e.g., 2) of the radiallyoutward extending members. In embodiments, where the proximal anchorincludes 2 radially outward extending members, the members may bepositioned on opposite sides of the axis (e.g., longitudinal axis) ofthe device.

In certain instances, each of the members extends radially outward fromthe axis of the device a distance of 1 mm or more, such as 2 mm or more,including 3 mm or more, or 4 mm or more, or 5 mm or more, or 6 mm ormore, or 7 mm or more, or 8 mm or more, or 9 mm or more, or 10 mm ormore. In some cases, each of the members extends radially outward fromthe axis of the device a distance of 3 mm or more. In certainembodiments, each of the members extends radially outward from the axisof the device a distance of 1 to 10 mm, such as 2 to 9 mm, including 4to 8 mm, or 5 to 7 mm. In some instances, each of the members extendsradially outward from the axis of the device a distance of 4 to 8 mm.

Sinus Dilator Cone-Shaped Distal Tip

In certain embodiments, the sinus dilator includes a distal tip. Thedistal tip may be configured to facilitate inserting the sinus dilatorinto a stenotic opening (e.g., a setnotic sinus ostium). For example,the distal tip of the sinus dilator may have a shape that facilitatesinsertion into a stenotic opening. In certain instances, the distal tiphas a tapered shape. By tapered is meant that the cross-sectional areaof the distal tip decreases from the proximal end of the distal tip tothe distal end of the distal tip, such that the cross-sectional area ofthe distal end of the distal tip is less than the cross-sectional areaof the proximal end of the distal tip. Various tapered shapes may beused for the distal tip, such as, but not limited to, a cone-shape, apyramid shape, a frustum shape, and the like. In some instances, thedistal tip has a cone-shape.

In certain instances, the cone-shaped tip has an apex angle of 10° to80°, or 20° to 70°, or 30° to 70°, including 40° to 70°, such as 50° to70°. In certain cases, the cone-shaped tip has an apex angle of 60°.

In certain embodiments, the distal tip includes a proximal surface incontact with the driver of the sinus dilator. The proximal surface ofthe distal tip may be configured to direct expansion of the driverradially outwardly from an axis (e.g., the longitudinal axis) of thesinus dilator, rather than in a direction that is parallel to thelongitudinal axis of sinus dilator.

In certain instances, the tip is made from a material that issubstantially rigid, such that it can direct expansion of the driverradially outwardly from an axis (e.g., the longitudinal axis) of thesinus dilator without substantially changing shape (e.g., bending). Insome cases, the tip is made from a material, such as, but not limitedto, metal, plastic, ceramic, combinations thereof, and the like.

In certain embodiments, sinus dilator has a passageway (e.g., a centralpassageway or conduit) extending through at least a distal end of thesinus dilator. In these embodiments, the tip may include a postextending proximally from the proximal face of the tip. The proximallyextending post may be configured to engage the passageway. For example,the proximally extending post may be configured to be inserted into thepassageway. Insertion of the proximally extending post into thepassageway of the sinus dilator may facilitate attachment of the tip tothe sinus dilator.

One embodiment of an osmotic dilator 100 which illustrates severalaspects of the present disclosure is shown in a side view in FIG. 3, inend view in FIG. 4, and in a sectional view in FIG. 5. The dilator 100includes an osmotic driver 110, a tapered distal tip 106, a proximalanchor 107 and a mounting member 109. Dilator 100 is shown in anon-expanded configuration in FIGS. 3 to 5. Dilator 100 includes tube101 (e.g., a non-collapsible metal or plastic tube) having the osmoticdriver 110 disposed thereon. As best shown in FIG. 5, the driver 110 iscomprised of an inner membrane 102 disposed on the tube 101, two osmotictablets 103, 104 threaded over the membrane 102 and tube 101 and anelastic semipermeable membrane 105 applied thereover. In use, thedilator 100 is placed in the sinus opening of a living subject,typically a human subject. Water from the subject's body and tissuespermeates through the elastic semipermeable membrane 105 due to thepresence of an osmotic pressure difference caused by the osmoticallyactive agent(s) contained in tablets 103 and 104. As water permeatesinto the tablets 103, 104, they begin to swell. Since tube 101 is madeof an incompressible material (e.g., stainless steel) and since anchor107 and tip 106 are also made from relatively incompressible materials(e.g., plastic, metal or ceramic), the swelling of tablets 103, 104causes the device 100 to expand in a radially outward direction. Inother words, the diameter of osmotic driver 110 increases. The swellingtablets 103, 104 cause the elastic membrane 105 to expand to accommodatethe increasing volume of the tablets 103, 104. As disclosed in greaterdetail in U.S. patent application Ser. No. 13/219,505, filed Aug. 26,2011, the disclosure of which is incorporated herein by reference, theexpanding osmotic driver 110 exerts pressure on the surrounding tissueand bone of the sinus opening, causing the opening to permanentlydilate. By controlling membrane thickness and composition, the periodfor complete expansion of the driver 110 is at least 0.5 hours.Expansion over a period of at least 0.5 hours is desirable since itavoids patient discomfort and tissue damage experienced with abruptshort-term dilation times as are encountered in balloon sinuplastyprocedures. In those applications where the dilation procedure using thedilators disclosed herein occurs in a physician's office setting whilethe subject is awake and waiting, dilation typically occurs over aperiod of less than 2 hours, though longer dilation times may optionallybe used.

In accordance with one aspect, the dilator 100 includes a tapered distaltip 106 that can be formed of plastic, metal or ceramic. Tip 106 may besecured to the tube 101, e.g., by gluing post 108 into the central lumenof tube 101 or by creating a mechanical (e.g., screw threads) orfriction connection between tube 101 and post 108. As shown in FIG. 5,the distal surface of tip 106 is tapered at an angle α relative to theaxis of the device, which provides a conical shape to the distal side ofthe tip 106. The tapered tip 106 makes it easier for the physician toinsert the dilator 100 into the closed or partially closed sinus ostium.In certain embodiments, the angle α ranges from 20° to 70°. In otherembodiments, the angle α ranges from 50° to 70°. In other embodiments,the angle α is 60°.

FIGS. 6 and 7 show an alternate embodiment of the osmotic dilator 100shown in FIGS. 3 to 5. In this embodiment, dilator 120 has a tapereddistal tip 126. Like distal tip 106 of dilator 100, distal tip 126 alsohas a conical shape and the angle α ranges mentioned above for tip 106.Unlike tip 106, tip 126 has a passageway (e.g., a conduit) 127 that isin fluid communication with the central lumen of tube 121. Thus whendilator 120 is inserted into the sinus ostium, the passageway 127 andtube 121 allow gas and fluid to be introduced into the paranasal sinuscavity, or to come out of the paranasal sinus cavity. Thus bodily fluidssuch as mucous and blood can be drained out of the sinus cavity throughpassageway 127. Likewise fluids such as a drug solution, saline, etc.can be introduced into the sinus cavity via the lumen of tube 121 andpassageway 127. The conical tip 126 can be slipped over tube 101 andsecured to the outside of tube 101 with adhesive. Alternatively, theinterior surface of passageway 127 can be formed with screw threads andtube 101 can be formed with matching threads in order to secure the tip126 to tube 101. Once screwed on, the tip 126 in this configuration canbe further bonded with a small amount of adhesive. In yet anotherconfiguration, the conical tip 126 with passageway 127 can be slippedonto tube 101 which tube end is then formed with a slight flare wherethe diameter of the flare is greater than the diameter of passageway127.

Although FIGS. 3 through 7 show conical tips 106, 126 having arelatively flat angled outer surface, those skilled in the art willappreciate that the outer surface of tips 106, 126 can also be curved orrounded, e.g., to form a bullet-shaped distal end, as long as thesurfaces approximate the angle α ranges specified above for flat outersurfaces. Thus, the terms “conical” and “cone-shaped” when referring totips 106, 126 refer to both flat and curved outer distal surfaces.

In accordance with another aspect, the device 100 includes a proximalanchor 107 positioned adjacent the proximal end thereof. Anchor 107 maybe secured (e.g., by gluing) to the tube 101. As best shown in FIG. 4,the proximal anchor 107 has two projecting members 111, 112 that extendradially outward from the central axis of the dilator 100 a sufficientdistance and having sufficient stiffness, that the anchor 107 cannot beeasily pushed through the sinus ostium during dilator 100 placement. Fora device used to dilate a maxillary sinus, the projecting members eachtypically extend out a distance of at least about 3 mm from the axis ofthe device 100. In other embodiments the projecting members eachtypically extend out a distance of about 4 to 8 mm from the axis of thedevice 100. The total extension of the two projecting members 111, 112should be greater than the maximum diameter achieved by the osmoticdriver 110. Thus, for a driver 110 having a maximum expanded diameter of5 mm, each of the projecting members extend out at least 3.5 mm from thecentral axis of the device 100. In this way, the anchor 107 prevents thedevice 100 from being squeezed out of the maxillary sinus opening 11 andinto the cavity of the maxillary sinus (MS) during device expansion. Incertain embodiments, the anchor 107 can include only a single projectingmember 111 or 112.

As best shown in FIG. 4, the projecting members 111 and 112 extend outfrom opposite “sides” of device 100 which gives the anchor 107 a more2-dimensional configuration than if the projecting members extended outfrom the entire circumference of device 100. As shown in FIGS. 17 and18, such a 2-dimensional configuration is helpful to navigate device 100through a subject's nostril and past bony turbinates 17 and 18 locatedin nasal passageway 15 en route to placing device 100 in the maxillarysinus opening 11.

Referring now to FIGS. 5 and 7, in cases where the dilator 100 is to beused to dilate the maxillary sinus ostium, the distance d between thedistal ends of the projecting members 111, 112 and the proximal end ofthe dilator 100 (or 120) should be sufficient to allow the proximal endof the dilator to engage a wall 16 of the nasal passageway 15 whichfaces the maxillary sinus opening 11. That is to say that the proximalend of the dilator engages or abuts against the wall 16 when theexpanding portions of the dilator 100 (or 120) are positioned within themaxillary sinus opening 11. In certain embodiments, distance d rangesfrom about 3 to 6 mm for a dilator 100 that is adapted to dilate themaxillary sinus opening 11 of an adult human. In other embodiments, thedistance d ranges from 4 to 5 mm. As best shown in FIG. 18, when dilator100 (or 120) is positioned within opening 11, the proximal end ofdilator 100 abuts against wall 16. This abutment keeps dilator 100 frombeing squeezed out of the opening 11 and into the passageway 15 asdilator 100 expands. Similarly, the projecting members 111 and 112 ofproximal anchor 107 prevent the dilator 100 from being squeezed into themaxillary sinus cavity (MS) as dilator 100 expands.

The proximal anchor 107 and mounting member 109 can be a singleintegrated item, or separate items as shown in FIG. 5. When formed asseparate items, mounting member 109 can be attached to tube 101 usingadhesive and/or provided with internal threads that screw onto matchingthreads on the external surface of tube 101. The threaded mountingmember 109 can be further secured with a small amount of adhesive.Alternatively, member 109 can be slipped over tube 101 which tube ismechanically flared on the end such that the outside diameter of theflare is greater than the inside diameter of member 109. One advantageof having mounting member 109 in a two-part assembly is that proximalanchor 107 can be composed of a soft, flexible material suitable toconform with live tissue structures while the mounting member 109 can bemade of a hard material which provides a more secure adhesive ormechanical connection to tube 101. Together anchor 109, the proximal endportion of tube 101 and member 109 provide anchoring which keeps thedevice 100 locked in the sinus opening during device 100 expansion andprevents the device 100 from being squeezed out of the sinus opening ineither direction; the projecting members 111 and 112 prevent the device100 from being squeezed into the maxillary sinus cavity (MS), while themember 109 and the proximal portion of tube 101 prevent the device 100from being squeezed into the nasal cavity. In certain embodiments, thisanchoring configuration is simpler than a dual anchor design (e.g., adevice with both a proximal and distal anchor), since there is no needto have a distal anchor which must be initially pushed through thestenotic sinus opening. The single anchor with bi-directional anchoringfunctionality is particularly useful for short term dilations (e.g.,dilation times of up to about 2 hours duration), e.g., where the patientnever leaves the doctor's office while the device 100 is in use.

The insertion of a dilator 100 into a stenotic paranasal sinus openingis as follows. A maxillary sinus opening is used for the purpose ofillustration. Referring first to FIG. 8, there is shown one embodimentof a sinus ostium dilator insertion device 200. Device 200 has a handle202, a cannula 201 mounted on the distal end 204 of handle 202, thehandle 202 having a slidable trigger 203. The distal end of cannula 201has a bend 206 and a slotted flange 209 upon which dilator 100 ismounted. The slots in flange 209 are sized to slidably engage theprojecting members 111 and 112 of proximal anchor 107 such that theprojecting members 111 and 112 extend out of the slots of flange 209 andprevent axial rotation of the dilator 100 during insertion into astenotic sinus opening (see also FIGS. 3-5). Referring now to FIGS. 10to 12, with dilator 100 mounted onto the distal end of device 200, thesliding trigger 203 is in its proximal position. The trigger 203 isconnected to flexible rod 205 via conventional means and at least oneslot in handle 202 (the connection is not shown in the figures). Rod 205is slidably positioned within cannula 201. The rod 205 can be forexample made from metal or plastic and has a diameter just slightly lessthan the inner diameter of cannula 201. The proximal end of rod 205 isoperatively connected to trigger 203 by conventional means. With thesliding trigger 203 oriented in the proximal position (e.g., the rightposition as shown in FIGS. 10 and 12), the dilator 100 is mounted on thedistal end of insertion device 200 and is ready for deployment into asinus opening. In this position, the rod 205 is recessed a sufficientdistance from the distal end of cannula 201 to accommodate mountingmember 109 to fit within the interior lumen of cannula 201.

In use, and as best shown in FIGS. 17 and 18 using the maxillary sinus(MS) for purposes of illustration, the mounted dilator 100, and cannula201 are advanced through the subject's nostril and then through thenasal passageway 15, until the distal tip of dilator 100 abuts againstthe stenotic opening 11. Then the physician applies further force onhandle 202 and pushes the dilator 100 into the sinus opening 11 untilthe projecting members 111 and 112 of proximal anchor 107 abuts againstthe tissue surrounding the nasal passageway side of opening 11. Becausethe proximal anchor 107 abuts against the ends of the slots in flange209, the dilator 100 can be pushed into a narrowed, stenotic and/orcompletely closed opening 11 by the physician applying a distallyoriented pushing force via the handle 202. Once in position within theopening 11, the physician may slide the trigger 203 to the distalposition (e.g., the left position as shown in FIGS. 13, 14, 15 and 16),and the rod 205 is advanced out of the interior lumen of cannula 201which causes the dilator 100 to be pushed off the distal end of device200. Following, the insertion device 200 is withdrawn from the patient.As mentioned earlier and as shown in FIG. 18, the inserted dilator 100has the proximal end of mounting member 109 abutting against the tissueof wall 16 (see also FIG. 17) facing the sinus opening 11. Likewise theprojecting members 111 and 112 of proximal anchor 107 abut against thetissue surrounding the nasal passageway side of opening 11. In this way,the dilator 100 is substantially anchored in place during its expansionphase and will not be squeezed out of the opening 11 during theexpansion.

In certain embodiments, device 200 includes a light source (not shown inthe figures), which in some instances is a directional light source,such as a fiber optic light source, a laser (e.g., a low energy laser),and the like. The light source emits light into the lumen of cannula 201using known light directing means and a light-reflecting interiorsurface of cannula 201. In some embodiments, rod 205 and dilator 100 (or120) are also constructed of light transmitting and/or translucentmaterials so that the light from the light source causes at leastportions of the dilator 100 (or 120) to become illuminated. Theillumination may have sufficient intensity so that the emitted light canbe seen through the patient's facial tissue. The position of theilluminated dilator 100 (or 120) may help the physician to correctlyposition the dilator in the ostium of a paranasal sinus. Alternatively,the dilator 120 described herein may be placed using an illuminatedguide wire that extends through the cannula 201 and/or through rod 205and optionally through the internal lumen of tube 121 and passageway 127of dilator 120.

Other suitable dilator insertion devices are disclosed in FIGS. 3-12,18-20 and 24 of U.S. patent application Ser. No. 13/219,497 filed Aug.26, 2011, the disclosure of which is incorporated herein by reference.

Sinus Dilators Configured for Drug Delivery

In certain embodiments, the device (e.g., sinus dilator) includes one ormore drug reservoirs configured to deliver a drug to the subject whilethe device is positioned within the stenotic opening. The drug reservoirmay be configured to deliver the drug locally to the tissues surroundingthe device while the device is in use. For example, the drug reservoirmay be configured to deliver the drug to one or more of the interiortissues of the stenotic opening, the interior lumen of the paranasalsinus, the tissues of the stenotic opening, the exterior tissues of thestenotic opening, and the nasal cavity.

The one or more drug reservoirs may have a variety of differentconfigurations. For example, embodiments of the sinus dilator mayinclude two drivers as described above (e.g., a proximal driver and adistal driver). In these embodiments, the drug reservoir may bepositioned between the first and second drivers. In these instances,positioning of the drug reservoir between the first and second driversmay facilitate delivery of the drug to one or more of the interiortissues of the stenotic opening, the interior lumen of the paranasalsinus, and the like. For instance, in certain embodiments, the devicemay be configured to deliver the drug from the drug reservoir throughthe action of the first and second drivers. In embodiments where thedrivers include a swellable polymer or an osmotically active agent,expansion of the drivers may apply external pressure on the sides of thedrug reservoir contacting the first and second drivers and push the drugout of the drug reservoir. For example, expansion of the first andsecond drivers may compress the drug reservoir and thus force the drugout of the drug reservoir. As such, in certain embodiments, the drugreservoir is configured to release a drug as the first and seconddrivers (e.g., first and second osmotic drivers) expand from anon-expanded configuration to an expanded configuration. In theseembodiments, the expandable portion of the sinus dilator may include anelastic semipermeable membrane. The expandable portion may surround thedrivers of the sinus dilator, such that the drivers are within theperiphery of the expandable portion. As such, in certain embodiments,the device includes a drug reservoir positioned between the first andsecond drivers and within the periphery of the expandable portion. Anelastic semipermeable membrane may facilitate drug delivery from thedevice as the drug diffuses through the membrane during use of thedevice. In some cases, the portion of the membrane overlying the drugreservoir may include one or more orifices through which drug releasedfrom the drug reservoir can pass through to be released to thesurrounding environment.

In other embodiments, the sinus dilator includes a drug, where the drugis the osmotically active agent in the driver of the sinus dilator. Insome instances, the osmotically active agent is a drug (e.g., anosmotically active drug agent). In these embodiments, the driver of thesinus dilator may be configured to expand osmotically as describedherein, as well as release the drug from the device into the surroundtissues. In some instances, including an osmotically active agent thatis a drug may facilitate a simplification of the device as theosmotically active agent acts both as the osmotically active agent forthe driver and is the drug (e.g., the pharmacologically active agent)that may be released from the device during use. In some embodiments,the expandable portion of the sinus dilator may include an elasticsemipermeable membrane. An elastic semipermeable membrane may facilitatedrug delivery from the device as the drug diffuses through the membraneduring use of the device.

In certain embodiments, as discussed above, the driver includes anosmotically active drug agent. The driver may also include othercomponents in the driver composition, such as, but not limited to, asolvent, a diluent, a lubricant, an excipient, combinations thereof, andthe like. In some cases, the driver may also include a non-drugosmotically active agent as described herein. In some instances, thedriver includes a vehicle, such as a liquid vehicle for carrying theosmotically active drug agent. For example, the osmotically active drugagent may be present in a liquid vehicle as a finely-divided dispersionor as a solution. The vehicle may be comprised of one or more of thefollowing: aqueous media including water; water with surfactant;water-in-oil emulsion; oil-in-water emulsion; non-aqueous media;ethanol; butanol; polyethylene glycol; poloxamer; glycerin;caprylocaproyl polyoxyl-8 glycerides; diethylene glycol monoethyl ether;glyceryl distearate; polysorbates such as polysorbate 20, 60, or 80;triacetin; benzyl alcohol; castor oil polyoxyl; castor oil polyoxylhydrogenated; nut oils such as peanut oil; seed oils such as cottonseed,sesame oil, etc.; bean oil such as soy bean oil; a paste such aspolyoxyl 15 hydroxystearate, caprylic glycderides, etc.; hydrogenatedcoco-glycerides; short chain partial glycerides such as gylceryl mono-,di- and tri-hexanoate; caprylic/capric glycerides; glycerol monooleate;glycerol ricinoleate; mixtures of the above; and the like.

In certain embodiments, the drug is water soluble. In some instances,the drug is an antibiotic, an anti-inflammatory drug, a localanesthetic, an analgesic, or a combination thereof. For example, thedrug may be selected from antibiotics, anti-inflammatory drugs,anesthetics (e.g., local anesthetics), analgesics (e.g., locally actinganalgesics), drugs that reduce bleeding (e.g., vasoconstrictors),combinations thereof, and the like. In certain embodiments, antibioticsinclude levofloxacin, moxifloxacin, amoxicillin, clavulanic acid,clarithromycin, azithromycin, cefuroxime, ciprofloxacin, salts thereofand combinations thereof and the like. In some instances,anti-inflammatory drugs include methylprednisolone, dexamethasone, saltsthereof and combinations thereof and the like. In some cases, localanesthetics include lidocaine, bupivacaine, ropivacaine, tetracaine,salts thereof and combinations thereof and the like. In certainembodiments, locally acting analgesics include: acetaminophen; Cox-2inhibitors, such as celecoxib and rofecoxib and the like; NSAIDS such asdiclofenac, ibuprofen, ketoprofen, naproxen, piroxicam, aspirin and thelike; opioids such as morphine; opioid agonists such as tramadol and thelike. In certain embodiments, vasoconstrictors include oxymetazoline,epinephrine, tranexamic acid, salts thereof, combinations thereof, andthe like. In certain instances, the drug reservoirs may include acombination of drugs, such as a combination of an NSAID, ananti-inflammatory drug and a vasoconstrictor. For example, the drug mayinclude OMS103HP (Omeros Corp., Seattle, Wash.), which includes an NSAID(ketoprofen), an anti-inflammatory drug (amitriptyline) and avasoconstrictor (oxymetazoline).

In some instances, the drug includes one or more of a corticosteroid(such as, but not limited to, triamcinolone, fluticasone propionate,etc.), glucocorticosteroid (such as, but not limited to, mometasonefuroate, budesonide, beclomethasone dipropionate, ciclesonide, etc.), abeta-2-angonist (such as, but not limited to, formoterol fumarate,etc.), combinations thereof, and the like.

Tablet Compression Force

Aspects of the present disclosure include a method of making a devicefor dilating a stenotic opening of a paranasal sinus in a subject. Themethod includes forming an osmotic driver in the form of a tablet and anexpandable membrane disposed peripherally therearound. The tablet iscomprised of an osmotically active agent and an osmopolymer. The driveris configured to expand from a non-expanded configuration to an expandedconfiguration. The non-expanded configuration is sized to be positionedwithin the stenotic opening. The method includes compressing the tabletsuch that the tablet is formed having a smooth outer surface with noflashing. By “flashing” is meant excess material attached to a molded,forged, or cast product, which is usually removed. Flashing is typicallycaused by leakage of the material between the two surfaces of a mold(beginning along the parting line between the two halves of the mold) orbetween the base substrate and the mold. In some instances, forming atablet with substantially no flashing (e.g., with substantially smoothouter surfaces) simplifies the method of manufacturing since excessflashing need not be removed from the compressed tablets before usingthe compressed tablets in the sinus dilator. In certain instances,forming a tablet with substantially no flashing (e.g., withsubstantially smooth outer surfaces) facilitates the manufacture of thesinus dilator by minimizing damage to the elastic semipermeable membranesurrounding the osmotic tablet of the sinus dilator.

In certain embodiments, the method includes compressing the osmoticallyactive agent and the osmopolymer in a tablet press. In order to form thetablet with substantially no flashing, the tablet may be compressed witha force less than that which would produce excess flashing. For example,in some cases, the method includes compressing the tablet using acompression force of 200 lbs or less, such as 150 lbs or less, including100 lbs or less, or 90 lbs or less, or 80 lbs or less, or 70 lbs orless, or 60 lbs or less, or 50 lbs or less, or 40 lbs or less, or 30 lbsor less, or 20 lbs or less, or 10 lbs or less. In certain cases, themethod includes compressing the tablet using a compression force of 100lbs or less. In certain instances, the method includes compressing thetablet using a compression force of 10 lbs to 200 lbs, such as 10 lbs to150 lbs, including 10 lbs to 100 lbs, or 20 lbs to 90 lbs, or 20 lbs to80 lbs or 20 lbs to 70 lbs, or 20 lbs to 60 lbs, or 20 lbs to 50 lbs. Incertain cases, the method includes compressing the tablet using acompression force of 20 lbs to 70 lbs. In certain instances, the methodincludes compressing the tablet using a compression pressure of 5 to 150mPa, such as 5 to 100 mPa, including 5 to 90 mPa, or 10 to 80 mPa, or 10to 70 mPa, or 15 to 65 mPa, or 20 to 65 mPa, or 25 to 65 mPa, or 30 to65 mPa, or 30 to 60 mPa, or 30 to 55 mPa, or 30 to 50 mPa. In somecases, the method includes compressing the tablet using a compressionpressure of 15 to 65 mPa. For example, the method may includecompressing the tablet using a compression pressure of 30 to 150 mPa.

In some cases, the compression force is still sufficient to produce atablet that has sufficient cohesiveness such that the tablet remains insubstantially one piece after compression and does not break, chip,disintegrate, etc. upon handling of the tablet during the manufacturingand use of the sinus dilator.

In accordance with certain aspects, the osmotic salt tablets 103, 104are formed by compression molding the tablets using only about 20 to 70lbs force (see e.g., FIG. 5). The annular shaped tablets 103, 104 can beformed by compressing a tablet granulation composition in a tablet pressusing flat-faced beveled round tooling having an outside diameter of 2.7mm and an inside diameter of 0.92 mm. The lower compression forceresults in less flashing of tablet granulation material duringcompressing which results in smoother tablet surfaces substantiallydevoid of rough edges. Smoother tablet surfaces result in fewer defectsin the elastic semipermeable membrane 105 that is applied thereon.

Insertion Device Recessed Push Rod

As described above, in some embodiments, the sinus dilator includes anelongated proximal end. In these embodiments, the insertion device maybe configured to have a shape and size compatible with the elongatedproximal anchor of the sinus dilator. In some instances, the insertiondevice is configured such that the sinus dilator can be removablymounted at the distal end of the insertion device. In certain cases, thehollow elongated member of the insertion device has a distal end sizedsuch that at least a portion of the elongated proximal end of the devicefits inside the distal end of the hollow elongated member of theinsertion device. In some instances, the interior elongated member ofthe insertion device is recessed within the hollow elongated member toaccommodate the elongated proximal end of the sinus dilator in thehollow elongated member of the insertion device.

During use, the actuation of the trigger may cause the interiorelongated member to displace such that at least a portion of theinterior elongated member that is inside of the distal end of the hollowelongated member is displaced distally within the hollow elongatedmember. In some instances, the distal tip of the interior elongatedmember may push against the sinus dilator as the interior elongatedmember is displaced distally within the hollow elongated member. Assuch, in some instances, the interior elongated member is relativelydisplaceable with respect to the hollow elongated member such that uponactuation of the trigger, the interior elongated member is displaceddistally within the hollow elongated member. In certain instances, thetrigger is slidably coupled to the handle and the trigger is coupled tothe interior elongated member such that sliding the trigger relative tothe handle displaces the interior elongated member distally relative tothe hollow elongated member.

In certain embodiments, the distal end of the interior elongated memberis configured to mate with the proximal anchor of the sinus dilator. Forexample, the distal end of the interior elongated member of theinsertion device may include one or more slots configured to mate withthe one or more radially outward extending members of the proximalanchor described above. In some cases, at least a portion of eachradially outward extending member of the proximal anchor is configuredto fit within a corresponding slot at the distal end of the interiorelongated member of the insertion device. In some embodiments, matingthe proximal anchor to the distal end of the interior elongated memberof the insertion device facilitates inserting the sinus dilator into thesinus ostium by minimizing undesired rotation of the sinus dilator aboutits longitudinal axis as the sinus dilator is inserted into the sinusostium using the insertion device.

Aspects of the insertion device include a handheld member including ahandle and trigger and a hollow elongated member having a proximal endcoupled to the handheld member and a distal end having an opening to aninterior cavity of the hollow elongated member. The hollow elongatedmember includes a retention interface configured to removably couple toa proximal end of a sinus dilator. The insertion device includes aninterior elongated member extending within the interior cavity of thehollow elongated member. A distal end of the interior elongated memberis recessed from the distal end of the hollow elongated member adistance sufficient to accommodate insertion of the proximal end of thesinus dilator.

Insertion Device Distal Tip Angle

Aspects of certain embodiments include an insertion device for insertinga sinus dilator into a stenotic opening of a maxillary sinus of apatient. The device includes a handheld member, including a handle andtrigger, and a hollow elongated member having a proximal end coupled tothe handheld member and a distal end having a retention interface forremovably coupling to the sinus dilator. The hollow elongated member hasa middle section extending between the distal and proximal ends, themiddle section having an axis. The device includes an interior elongatedmember extending within the interior cavity of the hollow elongatedmember.

In certain embodiments, the distal end of the hollow elongated member isoriented at an angle of 0° to 150° relative to the axis, such as 10° to130°, including 20° to 120°, or 30° to 120°, or 60° to 120°, or 90° to120°, or 100° to 120°, or 105° to 115° relative to the axis. In someinstances, the distal end of the hollow elongated member is oriented atan angle of 110° relative to the axis. In certain embodiments, aninsertion device having a distal end with an angle as described abovemay facilitate insertion of a sinus dilator into a maxillary sinus of apatient.

In accordance with another aspect, and as shown in FIG. 9, the dilator100 has a bend 206 at the distal end thereof. The degree of bend 206 canbe measured as the angle θ that is formed between the axis of the middleportion of cannula 201 and the axis of dilator 100. In certainembodiments of insertion device that are particularly well adapted foraccessing the maxillary sinus opening 11, the angle θ ranges from 105°to 115°. In other embodiments, the angle θ is 110°.

As can be appreciated from the disclosure provided above, the presentdisclosure has a wide variety of applications. Accordingly, thefollowing examples are offered for illustration purposes and are notintended to be construed as a limitation on the invention in any way.Those of skill in the art will readily recognize a variety ofnoncritical parameters that could be changed or modified to yieldessentially similar results. Thus, the following examples are put forthso as to provide those of ordinary skill in the art with a completedisclosure and description of how to make and use the present invention,and are not intended to limit the scope of what the inventors regard astheir invention nor are they intended to represent that the experimentsbelow are all or the only experiments performed. Efforts have been madeto ensure accuracy with respect to numbers used (e.g. amounts,temperature, etc.) but some experimental errors and deviations should beaccounted for. Unless indicated otherwise, parts are parts by weight,molecular weight is weight average molecular weight, temperature is indegrees Celsius, and pressure is at or near atmospheric.

EXAMPLES Example 1

A distal osmotic tablet was fabricated according to the proceduresdescribed in Example 1 of U.S. patent application Ser. No. 13/219,505,filed Aug. 26, 2011, except as follows. First, Polyox 303 was siftedthrough a 100-mesh sieve. 8.5 grams of minus 100 mesh material wastransferred to a beaker. Sodium chloride powder was ground with a pestlein a mortar and sifted through a 100-mesh sieve. 15.0 grams of sizedsodium chloride was added to the Polyox. Next, Methocel E5 was siftedthrough a 100-mesh sieve. 1.25 g of the sized Methocel was added to thePolyox and sodium chloride. The resulting composition was stirred with aspatula to form a homogenous blend. 7 ml of denatured anhydrous ethanol(formula 3A) was slowly stirred into the blend to form a homogenous dampmass. The mass was passed through a 40 mesh sieve with a spatula to formgranules. The resulting granules were transferred to a beaker and driedovernight in forced air at 40° C. The dried granules were then sizedagain through the 40 mesh sieve and transferred to a screw-capped jar.An amount of magnesium stearate equal to 1 percent of the mass of thedried composition was weighed, sized through an 80-mesh sieve, andtumble mixed into the blend for two minutes. Portions of the resultinggranulation having a nominal weight of 19.5 mg were compacted intoannular shaped tablets using 60 pounds force with flat-faced beveledround tooling having an outside diameter of 2.7 mm and an insidediameter of 0.92 mm. This produced osmotic distal tablets having anominal length of 2.5 mm. The nominal weight of sodium chloride in thedistal tablets was 11.7 mg.

A proximal osmotic tablet composition was prepared using the sameprocedures and compositions except that the mass of Polyox was 10.98 gand the mass of sodium chloride was 12.5 grams. Additionally, 30 mg ofred ferric oxide pigment, previously sized to minus 100 mesh, wasincluded in the blend during the wet granulation step. The resultinggranulation was compacted with the 2.7 mm outside diameter 0.92 mminside diameter tooling at a nominal weight of 18.6 mg to produceproximal osmotic tablets having a nominal length of 2.5 mm. The nominalsodium chloride in the proximal tablets was 9.3 mg.

Next, stainless steel tubes of 304 stainless steel having an outsidediameter of 28 mils (0.7 mm) and an inside diameter of 20 mils (0.5 mm)were cut to lengths of 55 mm, de-burred and passivated using theprocedures described in Example 1 U.S. patent application Ser. No.13/219,505, filed Aug. 26, 2011. The tubes were then dip coated usingthe procedures described in Example 1 U.S. patent application Ser. No.13/219,505, filed Aug. 26, 2011, using a coating solution comprising11.7 parts Tecophilic HP93A-100, 1.3 parts polyvinyl pyrrolidone, and 87parts n-methyl pyrrolidone and dried to a coating thickness of 3-4 mils(0.076-0.102 mm). Then, one proximal tablet and one distal tablet werethreaded onto the center of a coated tube such that they were in contactwith each other. The resulting subassembly was then dip coated with thesame membrane coating solution using the procedures described in Example1 U.S. patent application Ser. No. 13/219,505, filed Aug. 26, 2011, anddried to a nominal coating thickness on the osmotic tablets of 13 mils(0.3 mm).

Next, excess membrane material was trimmed away from the stainless steeltube using a jeweler's lathe such that 2 mm of membrane remained at eachend of the pair of tablets. The metal tube was then cut such that 4.2 mmof bare metal tube remained on the proximal end and 1.7 mm of bare metaltube remained on the distal end. A proximal anchor comprising injectionmolded Pebax having two wings and a shape substantially as shown inFIGS. 3 and 4 was slipped onto the proximal end abutting the trimmedmembrane. An extruded sleeve of Nylon 12 tubing having an insidedimension of approximately 31 mils (0.8 mm), an outside diameter of 70mils (1.8 mm), and a length of about 50 mils (1.3 mm) was then bondedonto the bare stainless steel tubing of the proximal end using Loctite4011 cyanoacrylate adhesive and dried at room temperature for 2 days.Next, a distal tip that had been injection molded from Nylon 66 wasfitted onto the distal end of the tube abutting the trimmed membrane andadhered with Loctite 4011. The tip had a conical configuration with thewide end of the cone abutting the membrane. Dimensions of the conicaltip were approximately 80 mils (2 mm) tapering down to approximately 45mils (1.1 mm) over a length of approximately 50 mils (1.3 mm). Theconical tip had a central hole running lengthwise having an insidediameter of approximately 32 mils (0.8 mm).

The resulting dilator was tested in a USP paddle test with 500 ml ofdistilled water at a temperature of 37° C. using a paddle rotation speedof 50 revolutions per minute. The device expanded over duration of 1hour. The proximal tablet expanded during that period from 3.4 mm to 5.3mm while the distal tablet expanded from 3.4 mm to 5.4 mm to form thetapered configuration of an in situ osmotic anchor.

The preceding merely illustrates the principles of the disclosure. Allstatements herein reciting principles, aspects, and embodiments of thedisclosure as well as specific examples thereof, are intended toencompass both structural and functional equivalents thereof.Additionally, it is intended that such equivalents include bothcurrently known equivalents and equivalents developed in the future,e.g., any elements developed that perform the same function, regardlessof structure. The scope of the present disclosure, therefore, is notintended to be limited to the exemplary embodiments shown and describedherein. Rather, the scope and spirit of present disclosure is embodiedby the appended claims.

1. A device for dilating a stenotic opening of a maxillary sinus in asubject, the device comprising: (a) a self-expanding osmotic driverconfigured to expand an expandable portion from a non-expandedconfiguration to an expanded configuration, the osmotic drivercomprising a first osmotic driver and a second osmotic driver positioneddistally to the first driver; and (b) the expandable portion disposedperipherally around the first and second osmotic drivers and configuredto expand from the non-expanded configuration to the expandedconfiguration, wherein the non-expanded configuration is sized to bepositioned within the stenotic opening; wherein the second driver isconfigured to have (i) a faster rate of expansion than a rate ofexpansion of the first driver, and (ii) a duration of expansion lessthan a duration of expansion of the first driver, whereby the seconddriver is configured to prevent the device from being expelled from thestenotic opening and into the nasal cavity during device expansion. 2.The device of claim 1, wherein the second driver is configured to have aduration of expansion of 2 hours or less.
 3. The device of claim 1,wherein each of the first and second drivers comprises an osmoticallyactive agent, the second osmotic driver having a concentration of theagent greater than the concentration of the agent in the first driver.4. The device of claim 3, wherein the osmotically active agent in thesecond driver has a concentration of 45 to 75 wt % and the osmoticallyactive agent in the first driver has a concentration of 35 to 65 wt %.5. The device of claim 1, wherein each of the first and second driverscomprises an osmopolymer, the second driver having a concentration ofthe osmopolymer that is less than the concentration of the osmopolymerin the first driver.
 6. The device of claim 5, wherein the osmopolymerin the first driver has a concentration of 30 to 60 wt % and theosmopolymer in the second driver has a concentration of 20 to 50 wt %.7. The device of claim 1, wherein the second driver is configured tohave a diameter greater than the diameter of the first driver during aperiod of stenotic opening dilation; and the second driver is configuredto have a diameter less than the diameter of the first driver followingsaid period of stenotic opening dilation.
 8. The device of claim 1,wherein the period of stenotic opening dilation is 0.5 hours or more. 9.The device of claim 7, wherein the period of stenotic opening dilationis 2 hours or less.
 10. The device of claim 1, comprising a conduitdefining an interior lumen, wherein the conduit comprises a distal endconfigured to be in fluid communication with an interior cavity of themaxillary sinus in the subject and a proximal end configured to be influid communication with a nasal cavity in the subject, and wherein theconduit is configured to allow fluid flow between the interior cavity ofthe maxillary sinus and the nasal cavity when the device is positionedwithin the stenotic opening.
 11. The device of claim 1, wherein theexpandable portion comprises a semipermeable membrane.
 12. The device ofclaim 1, comprising a proximal anchor proximate to the proximal end ofthe device, wherein the proximal anchor is configured to prevent thedevice from moving into a maxillary sinus cavity of the subject duringdevice expansion. 13-45. (canceled)
 46. A device for dilating a stenoticopening of a maxillary sinus in a subject, the device comprising: (a) aself-expanding driver configured to expand an expandable portion from anon-expanded configuration to an expanded configuration; and (b) theexpandable portion disposed peripherally around the driver andconfigured to expand from the non-expanded configuration to the expandedconfiguration, wherein the non-expanded configuration is sized to bepositioned within the stenotic opening; and (c) a proximal anchorproximate to the proximal end of the device, the proximal anchor beingsized and configured to prevent the device from passing through thestenotic opening into the maxillary sinus cavity; wherein the device hasan elongated proximal end having a sufficient length to contact a wallof the nasal cavity facing the stenotic opening when the device ispositioned within the stenotic opening.
 47. The device of claim 46,wherein the device has a length, measured from a point on the devicethat is immediately adjacent to the nasal passageway side of the sinusopening, to the proximal end of the device, of 3 to 6 mm.
 48. The deviceof claim 46, wherein the elongated proximal end forms at least a portionof the proximal anchor.
 49. The device of claim 46, wherein theelongated proximal end is configured to prevent the device from beingsqueezed out of the sinus opening and into the nasal passageway duringdevice expansion.
 50. The device of claim 46, wherein the proximalanchor comprises a member extending radially outward from an axis of thedevice.
 51. The device of claim 50, wherein the proximal anchorcomprises a pair of said radially outward extending members.
 52. Thedevice of claim 51, wherein the members are positioned on opposite sidesof a longitudinal axis of the device.
 53. The device of claim 52,wherein each of the members extends radially outward from the axis ofthe device a distance of 3 mm or more.
 54. The device of claim 52,wherein each of the members extends radially outward from the axis ofthe device a distance of 4 to 8 mm.
 55. The device of claim 54, whereinthe driver is configured to expand the expandable portion to a diameterof 7 mm or less.
 56. The device of claim 46, wherein the driver isconfigured to expand the expandable portion from the non-expandedconfiguration to the expanded configuration over a period of 0.5 hoursor more.
 57. The device of claim 56, wherein the driver is configured toexpand the expandable portion from the non-expanded configuration to theexpanded configuration over a period of 2 hours or less.
 58. The deviceof claim 46, wherein the driver is configured to expand the expandableportion by at least one of osmosis, a shape memory metal, a spring, aswellable polymer, a thermal expansion of a gas, a thermal expansion ofa liquid, a gas-generating chemical reaction, and a phase changeexpansion of a material.
 59. The device of claim 46, wherein the drivercomprises an osmotically active agent.
 60. The device of claim 59,wherein the expandable portion comprises a semipermeable membrane. 61.The device of claim 46, comprising a conduit defining an interior lumen,wherein the conduit comprises a distal end configured to be in fluidcommunication with an interior lumen of the maxillary sinus in thesubject and a proximal end configured to be in fluid communication witha nasal cavity in the subject, and wherein the conduit is configured toallow fluid flow between the maxillary sinus cavity and the nasal cavitywhen the device is positioned within the stenotic opening. 62-110.(canceled)